Accuracy Of Dobutamine Echocardiography Research Articles

Comparison of Exercise Electrocardiography, Technetium-99m Sestamibi Single Photon Emission Computed Tomography, and Dobutamine and Dipyridamole Echocardiography for Detection of Coronary Artery Disease in Hypertensive Women

To assess the performance of currently used stress tests for the detection of coronary artery disease (CAD) in a series of female hypertensive patients. We performed exercise electrocardiography (ECG), technetium-99m sestamibi (MIBI) single photon emission computed tomography, dobutamine and dipyridamole echocardiography, and coronary angiography in 76 hypertensive women. Of the 76 study patients, 31 (41%) had significant CAD. The sensitivity of exercise ECG (81%), MIBI scanning (90%), and dobutamine echocardiography (87%) was greater than that of dipyridamole echocardiography (61%). This finding resulted from the lower sensitivity of dipyridamole echocardiography in the detection of single-vessel CAD (47% vs 76%, 88%, and 82% for the other 3 methods). In contrast, the sensitivity of the 4 tests was similar in the detection of multivessel CAD. The specificity of exercise ECG (56%) and MIBI scanning (53%) was less than that of dobutamine (82%, both p <0.01) and dipyridamole (91%, both p <0.001) echocardiography. This finding related to the lower specificity of exercise ECG in patients with either left ventricular hypertrophy or ST-T abnormalities at rest compared to the specificity in patients without these disorders (33% vs 89%, p <0.01). A lower MIBI scan specificity was found only in patients with left ventricular hypertrophy (31% vs 66%, p <0.05). The overall accuracy of dobutamine echocardiography reached 84% compared to exercise ECG (66%, p <0.01), MIBI scan (68%, p <0.05), and dipyridamole echocardiography (79%, p <0.05). In conclusion, dobutamine echocardiography yielded satisfactory diagnostic accuracy for identifying CAD in hypertensive women. Although dipyridamole echocardiography had the greatest specificity, it might be limited in detecting mild CAD. Both exercise ECG and MIBI scanning had fare sensitivity; however, our findings limit the usefulness of these 2 tests in unselected patients.

Influence of myocardial tissue doppler on the accuracy of dobutamine echocardiography in novices and experts

Influence of myocardial tissue doppler on the accuracy of dobutamine echocardiography in novices and experts

Combined evaluation of rest-redistribution thallium-201 tomography and low-dose dobutamine echocardiography enhances the identification of viable myocardium in patients with chronic coronary artery disease

The purpose of this study was to evaluate whether combined evaluation by discriminant analysis of rest-redistribution thallium-201 tomography and low-dose dobutamine echocardiography enhances the accuracy in identifying viable myocardium in patients with chronic coronary artery disease. Rest-redistribution 201Tl has high sensitivity but low specificity in identifying viable myocardium, while the opposite is true for low-dose dobutamine echocardiography. Forty-six patients underwent low-dose dobutamine echocardiography and rest-redistribution 201Tl tomography on the same day. Rest echocardiography was repeated at least 30 days (mean 40+/-20) after myocardial revascularization. Discriminant analysis was applied to the results of 201Tl tomography and dobutamine echocardiography to classify a/dyskinetic segments as viable or non-viable. In 92 a/dyskinetic segments that were revascularized, rest-redistribution 201Tl tomography yielded an accuracy of 75%, while the accuracy of dobutamine echocardiography was 70% (P<0.05). When discriminant analysis was used, the combined evaluation gave an accuracy of 83% (P<0.05 vs both tests). These findings demonstrate that low-dose dobutamine echocardiography and 201Tl imaging are useful and complementary techniques for identifying viable myocardium in patients with chronic coronary artery disease. Combined evaluation by discriminant analysis significantly improves accuracy, although the cost-effectiveness of such an approach remains to be determined.

Influence of Gender on Physiologic Response and Accuracy of Dobutamine Echocardiography

Influence of Gender on Physiologic Response and Accuracy of Dobutamine Echocardiography

Influence of Gender on Physiologic Response and Accuracy of Dobutamine Echocardiography

Dobutamine echocardiography (DE) has been shown to be safe, feasible, and accurate for identification of coronary artery disease (CAD) in mixed populations. The purpose of this study was to examine gender differences in physiologic response and accuracy of DE. We studied 2,886 consecutive DEs, performed in 2,748 patients, 1,209 of whom (44%) were women. A standard incremental protocol (5 to 40 μg/kg/min in 3-minute stages) was followed by atropine and/or an additional stage with 50 μg/kg/min, if the heart rate response was inadequate. Hemodynamic and echocardiographic findings were recorded at each stage. Three hundred sixty-nine patients without previous cardiac intervention (including 135 women) also underwent cardiac catheterization within 1 year of DE. Significant coronary stenoses (defined angiographically as >50% diameter) were present in 67% of women and 65% of men, of whom 55% and 65%, respectively, had multivessel disease. Women had a higher baseline heart rate (76 ± 13 vs 73 ± 14 beats/min, p <0.0001), and showed a more rapid increase in heart rate at low dose, with a higher age-predicted maximum heart rate at peak. This led to test termination at target heart rate but a submaximum dose in 22% of women versus 15% of men (p <0.0001) and less frequent administration of atropine (29% vs 34%, p <0.01). Dose-limiting side effects (8% vs 7%) and submaximum heart rate responses (14% vs 17%) were comparable in men and women. Even after the exclusion of negative DE at submaximal heart rate responses, the overall sensitivity was significantly lower in women than men (78% vs 88%, p <0.05), both for single (72% vs 78%, p <0.05) and for multivessel disease (82% vs 93%, p <0.05). The low specificity in both genders (55% vs 46%) probably reflected post-test referral bias. Thus, physiologic responses to dobutamine stress are comparable in men and women, except for a more rapid heart rate response in women, but the accuracy of DE for diagnosis of CAD in women is less than in men.

Accuracy of Dobutamine Echocardiography for Detection of Myocardial Viability in Patients With an Occluded Left Anterior Descending Coronary Artery

Accuracy of Dobutamine Echocardiography for Detection of Myocardial Viability in Patients With an Occluded Left Anterior Descending Coronary Artery

Dobutamine-induced wall motion abnormalities: Correlations with myocardial fractional flow reserve and quantitative coronary angiography

Objectives. This study evaluated both the relation between dobutamine-induced wall motion abnormalities and the physiologic and morphologic features of epicardial coronary artery stenoses and the impact of the extent of the area at risk on the sensitivity of dobutamine echocardiography.Background. The accuracy of dobutamine echocardiography has traditionally been assessed by comparing results with stenosis geometry. Myocardial fractional flow reserve is a functional index of coronary stenosis severity that takes into account both anterograde and collateral flow and may therefore be a more appropriate standard for comparison.Methods. Seventy-five patients with normal left ventricular function, good echocardiographic images and an isolated corenary stenosis underwent, within 6 h, debutamine echocardiography, quantitative coronary angiography and intracoronary pressure measurements. Myocardial fractional flow reserve was calculated as the ratio of mean hyperemic distal coronary to aortic pressure.Results. The degree of dobutamine-induced dyssynergy correlated significantly with percent diameter stenosis (r = 0.68), area stenosis (r = 0.68) and minimal lumen diameter (r = 0.60) and markedly better with myocardial fractional flow reserve (r = −0.77). However, marked dispersion of the individual data was observed. The sensitivity of dobutamine echocardiography in detecting lesions with a minimal lumen diameter ≤1 mm and diameter stenosis ≥50% was 83% and 80%, respectively. All but one patient with a myocardial fractional flow reserve >0.75 had a normal stress test result. Among patients with a myocardial fractional flow reserve ≤0.75, the sensitivity of dobutamine echocardiography was significantly lower for lesions in vessels with a reference diameter ≤2.6 mm than for lesions in larger vessels (58% vs. 90%, p = 0.008).Conclusions. 1) The magnitude of wall motion abnormalities induced by dobutamine infusion correlates with angiographic and, more closely, with functional indexes of stenosis severity, even though a wide scatter is observed. 2) In patients with a functionally significant stenosis, the amount of myocardium at risk is a critical determinant of the accuracy of debutamine echocardiography.

Analysis of interinstitutional observer agreement in interpretation of dobutamine stress echocardiograms

Objectives. This study sought to determine the degree of interinstitutional agreement in the interpretation of dobutamine stress echocardiograms.Background. Dobutamine stress echocardiography involves subjective interpretation. Consistent methods for acquisition and interpretation are of critical importance for obtaining high inter-observer agreement and for facilitating communication of test results.Methods:Five experienced centers were each asked to submit 30 dobutamine stress echocardiograms (dobutamine up to 40 μg/kg body weight per min and atropine up to 1 mg) obtained in patients undergoing coronary angiography. Thus, a total of 150 dobutamine stress echocardiograms were interpreted by each center without knowledge of any other patient data. Left ventricular wall motion was assessed using a 16-segment model but was otherwise not standardized. No patient was excluded because of poor wage quality or inadequate stress level. Echocardiographic image quality was assessed using a five-point scale.Results. Angiographically significant coronary artery disease (≥50% diameter stenosis) was present in 95 patients (63%). By a majority decision (three or more centers), the sensitivity, specificity and accuracy of dobutamine echocardiography were 76%, 87% and 80%, respectively. Abnormal or normal results of stress echocardiography were agreed on by four or all five of the centers in 73% of patients (mean kappa value 037, fair agreement only). Agreement on the left anterior descending artery territory (78%) was similar to that for the combined right coronary artery/left circumflex artery territory (74%), and for specific segments the agreement ranged from 84% to 97% and was highest for the basal anterior segment and lowest for the basal inferior segment. Agreement was higher in patients with no (82%) or three-vessel coronary artery disease (100%) and lower in patients with one-or two-vessel disease (61% and 68%, respectively). Agreement on positivity or negativity of stress test results was 100% for patients with the highest image quality but only 43% for those with the lowest image quality (p = 0.003).Conclusions. The current heterogeneity in data acquisition and assessment criteria among different centers results in low inter-institutional agreement in interpretation of stress echocardiograms. Agreement is higher in patients with no or advanced coronary artery disease and substantially lower in those with limited echocardiographic image quality. To increase interinstitutional agreement, better standardization of image, acquisition and reading criteria of stress echocardiography is recommended.

Accuracy of dobutamine echocardiography for detection of myocardial viability in patients with occluded left anterior descending artery

Accuracy of dobutamine echocardiography for detection of myocardial viability in patients with occluded left anterior descending artery

Finding Hibernating Myocardium with Dobutamine Echo

Myocardial hibernation refers to ventricular dysfunction resulting from chronic ischemia, with partial recovery following revascularization. The clinical implications of distinguishing reversible, hibernating myocardium from infarcted myocardium are profound. The authors of this study sought to determine the accuracy of dobutamine echocardiography in identifying hibernating myocardium. This prospective study evaluated data from 20 patients with impaired ventricular function and stable coronary artery disease …