Dobutamine Stress Echocardiography For Diagnosis Research Articles

P556Left ventricular 4D Strain during dobutamine stress echocardiography for diagnosis of coronary artery stenosis in patients with intermediate pretest probability of coronary artery disease

P556Left ventricular 4D Strain during dobutamine stress echocardiography for diagnosis of coronary artery stenosis in patients with intermediate pretest probability of coronary artery disease

Magnetic resonance stress tagging in ischemic heart disease

High-dose dobutamine magnetic resonance stress testing has been shown to be superior to dobutamine stress echocardiography for diagnosis of coronary artery disease (CAD). We determined the feasibility of quantitative myocardial tagging during low- and high-dose dobutamine stress and tested the ability of global systolic and diastolic quantitative parameters to identify patients with significant CAD. Twenty-five patients suspected of having significant CAD were examined with a standard high-dose dobutamine/atropine stress magnetic resonance protocol (1.5-T scanner, Philips). All patients underwent invasive coronary angiography as the standard of reference for the presence (n = 13) or absence (n = 12) of significant CAD. During low-dose dobutamine stress, systolic (circumferential shortening, systolic rotation, and systolic rotation velocity) and diastolic (velocity of circumferential lengthening and diastolic rotation velocity) parameters changed significantly in patients without CAD (all P < 0.05 vs. rest) but not in patients with CAD. Identification of patients without and with CAD during low-dose stress was possible using the diastolic parameter of "time to peak untwist." At high-dose stress, none of the global systolic or diastolic parameters showed the potential to identify the presence of significant CAD. With myocardial tagging, a quantitative analysis of systolic and diastolic function was feasible during low- and high-dose dobutamine stress. In our study, the diastolic parameter of time to peak untwist as assessed during low-dose dobutamine stress was the most promising global parameter for identification of patients with significant CAD. Thus quantitative myocardial tagging may become a tool that reduces the need for high-dose dobutamine stress.

1.55 Comparison of thallium-201 exercise SPECT and dobutamine stress echocardiography for diagnosis of coronary artery disease in patients with left bundle branch block

1.55 Comparison of thallium-201 exercise SPECT and dobutamine stress echocardiography for diagnosis of coronary artery disease in patients with left bundle branch block

Comparison of bicycle, heavy isometric, dipyridamole-atropine and dobutamine stress echocardiography for diagnosis of myocardial ischemia

Several stress echocardiography (SE) modalities have been introduced for diagnosing coronary artery disease (CAD). Exercise and dobutamine SE are considered to have better diagnostic accuracy than vasodilator or isometric SE, but there are no studies in a single group of patients comparing these 3 tests with heavy 2-arm isometric SE. The purpose of this study was to determine the diagnostic characteristics of 4 SE methods in patients with chest pain. Altogether, 60 patients (age ± SD 55.1 ± 2.1 years) were tested with bicycle, heavy 2-arm isometric, dipyridamole-atropine and dobutamine SE. CAD (>50% stenosis) was present in 44 patients; 26 patients had 1-vessel disease. During bicycle SE, the double product at peak stress was higher than during dobutamine and dipyridamole-atropine SE (26.5 × 10 3, p <0.005 vs dobutamine and dipyridamole-atropine SE), and peak wall motion score index (1.40) was higher than during dipyridamole-atropine and isometric SE (1.26 and 1.07, respectively, p <0.05 vs bicycle SE). Bicycle , dipyridamole-atropine, and dobutamine SE had higher sensitivity than isometric SE (90%, 93%, 95%, and 30%, respectively, p <0.05 isometric SE vs others). There were no statistically significant differences with regard to specificity. Similarly, bicycle, dipyridamole-atropine, and dobutamine SE had a higher diagnostic accuracy than isometric SE (78%, 88%, 87% and 47%, respectively, p <0.05 isometric SE vs others). We conclude that bicycle, dipyridamole-atropine, and dobutamine SE have an equal diagnostic accuracy in detecting CAD despite higher double product and ischemic burden at peak stress during bicycle and dobutamine SE over dipyridamole-atropine SE. Heavy isometric SE is inaccurate.

Role of Dobutamine Stress Echocardiography for Diagnosis of Cardiac Allograft Vasculopathy

CARDIAC allograft vasculopathy (CAV) remains a main factor limiting long-term survival after heart transplantation (HTX). Manifestations of CAV include focal stenoses as well as diffuse longitudinal involvement of vessels and small vessel disease. The clinical diagnosis is difficult, as the heart is denervated and usually remains without functionally relevant reinnervation. Routine coronary angiography is therefore the mainstay of diagnosis of CAV; this technique, however, shows a pure luminogram and is not able to detect early changes of CAV, ie, changes in the thickness of the vessel wall. Intravascular ultrasound (IVUS) has emerged as most sensitive invasive method for diagnosis of CAV. IVUS, however, can only be used to analyze the major epicardial vessels and is not able to investigate the entire coronary artery tree. In addition, both angiography and IVUS are invasive, costly and not free of risk. Several tests employed for noninvasive detection of CAV have proven unsatisfactory. In some studies, this may be related to the mode of provocation of ischemia: physical exercise may be not adequate after HTX, as the chronotropic response to exercise is blunted due to denervation. Stress tests using vasodilators as dipyridamole, which induces relative differences of perfusion, may be less reliable in diffuse CAV, but appear to be superior to exercise tests. Pharmacologic stress testing using dobutamine can overcome the problems associated with other stress modalities. Indeed, dobutamine stress echocardiography (DSE) has emerged as the most promising noninvasive method for diagnosis of CAV. This article reviews our experience and published data on assessment of CAV by DSE.