Left ventricular volume analysis for the detection of coronary artery disease during dobutamine stress echocardiography in patients undergoing vascular surgery.

Abstract

The purpose of the study was to prospectively evaluate the effectiveness of left ventricular volume changes analysis as compared to wall motion assessment for detecting coronary artery disease during dobutamine stress echocardiography in patients undergoing elective vascular surgery. Left ventricular volumes, measured by using the ellipsoid biplane method combining the apical four- and two-chamber echocardiographic views, and classical wall motion score were determined at rest and peak stress (dobutamine infusion 5-40 microg/kg/min+/- atropine 0.25-1mg) in 68 consecutive patients. A positive test was defined as a decrease of less than 15% in left ventricular end-diastolic or end-systolic volume at peak stress for volume analysis and as an increase in score between rest and peak stress in one or more segments for wall motion assessment. Stress test was not analysable in five patients. Coronary angiography revealed significant coronary artery disease (coronary stenosis >or=70%) in 28/63 (44%) patients: one-vessel in 15, two- or three-vessel disease in 13. Overall sensitivity and specificity for coronary artery disease detection were 56% and 97% with left ventricular volume analysis, as compared to 64% and 89% with wall motion assessment. For patients with two- or three-vessel disease, sensitivity and specificity of volume analysis reached 92%. The present data suggest that left ventricular volume change analysis during dobutamine stress echocardiography could be a reliable method for the detection of extensive coronary artery disease for patients undergoing vascular surgery.