Relation between exercise and dobutamine stress–induced wall motion abnormalities and severity and location of stenosis in single-vessel coronary artery disease

Abstract

Background: Quantitative coronary angiography has been shown to allow accurate assessment of coronary stenosis. Exercise and dobutamine stress echocardiography both are established methods for assessing the functional importance of coronary stenosis. The relation, however, between exercise and dobutamine stress-induced wall motion abnormalities and the severity and location of stenosis remains controversial. Methods and Results: Thirty patients with single-vessel coronary artery disease with ≥50% minimal luminal reduction and stable angina participated in the study. Severity of coronary artery stenosis was assessed by means of computed angiography. During peak exercise echocardiography 23 patients had wall motion abnormalities and 7 did not. A positive test result was associated with severity of stenosis ≥80% for 65% of stenoses (P < .05 versus severity of stenosis <80%) and with a proximal location of 94% of stenoses (P < .01 versus middle and distal stenoses). A significant correlation was found between area of stenosis and difference in wall motion score between rest and peak exercise (r = 0.53, P < .01). The proportion of positive exercise stress was greater among stenoses with severity <80% (62% versus 46% dobutamine stress, P < .05). During dobutamine stress echocardiography 18 patients had wall motion abnormalities and 12 patients did not. A positive test result was associated with severity of stenosis ≥80% in 72% of stenoses (P < .05 versus severity of stenosis <80%) and with a proximal location in 81% of stenoses (P < .01 versus middle and distal stenoses). A weak correlation was found between area of stenosis and difference in wall motion score between rest and peak dobutamine stress (r = 0.37, P < .05). Conclusions: Among patients with single-vessel coronary artery disease, positive stress echocardiographic test results usually are associated with proximal ≥80% stenosis. Patients with <80% stenoses are more likely to have a positive exercise stress test result than a positive dobutamine stress test result. (Am Heart J 1999;138:873-9.)