764-3 Transesophageal Dobutamine Stress Echocardiography for the Evaluation of Patients with Chest Pain and Normal Coronary Arteries

Abstract

Demonstration of myocardial ischemia with noninvasive testing has been inconsistent in patients with chest pain and normal coronary arteries (CPNCA), thus raising doubts about the ischemic nature of their symptoms. We have shown that transesophageal dobutamine stress echocardiography (TEDSE) accurately reveals inducible myocardial ischemia in coronary artery disease (CAD) patients. Accordingly. to determine whether patients with CPNCA have similar evidence of myocardial ischemia during TEDSE. we studied 52 patients with CPNCA (17 men; age 49 ± 9 years). 16 (31%) of whom had ischemic-appearing ECG responses to treadmill exercise. Their results were compared to those of 62 CAD (≥70% stenosis of ≥1 coronary artery) patients (54 men; age 61 ± 10 years) and 21 normal volunteers (NV) (15 men; age 56 ± 7 years). Dobutamine was infused in stepwise increments up to 40 μ g/kg/min. TEDSE induced chest pain in 44(85%) patients with CPNCA, in 31 (50%) CAD patients. and in none of the NV (p < 0.001). Ischemic-appearing ECG changes developed in 17 (33%) patients with CPNCA. in 32 CAD patients (51%), and in only 1 15%) NV (p < 0.001). New or worsening wall motion abnormalities occurred in none of the patients with CPNCA. in 55 (89%) CAD patients. and in none of the NV Thus. despite successful provocation of chest pain and/or ECG changes, patients with CPNCA do not have evidence of myocardial ischemia during TEDSE. Therefore. TEDSE appears as a useful method for the identification of patients with chest pain of non-ischemic origin.