Value of Dobutamine Stress Echocardiography for the Detection of Multivessel Coronary Artery Disease

Abstract

Dobutamine stress echocardiography has been shown to accurately detect coronary artery disease (CAD), but it is not clear whether it has the ability to detect multivessel CAD relative to clinical and exercise electrocardiography. Therefore, the aim of this study was to evaluate the ability of dobutamine stress echocardiography to identify multivessel CAD and ascertain its incremental value when combined with clinical and exercise test variables. One hundred twenty-one consecutive patients referred for coronary arteriography on the basis of symptoms and exercise electrocardiography underwent dobutamine stress echocardiography. Significant multivessel CAD was defined as the presence of ≥70% diameter stenosis in ≥2 major epicardial arteries. Stepwise logistic regression analysis was performed using the clinical exercise test and echocardiographic variables. The strongest independent variables predicting the presence of multivessel CAD were systolic wall thickening index at peak stress (p <0.0001), presence of wall thickening abnormalities in multiple vascular territories (p = 0.001), and a history of acute myocardial infarction (p = 0.04). Furthermore, dobutamine echocardiography significantly enhanced the prediction of multivessel disease when combined with clinical and exercise test variables (p = 0.001). Dobutamine stress echocardiography adds independent and incremental information to clinical and exercise test variables for identifying multivessel CAD.