Copyright © 1991 by the European Society of Cardiology.
© 1991 The European Society of Cardiology
Dobutamine stress test to diagnose the presence and severity of coronary artery lesions in angina
Coronary Care Unit, Division of Coronary Diseases, La Paz Hospital Madrid, Spain
Received 28 June 1990; revised 23 October 1990; .
Correspondence: I. Coma-Canella, Unidad Coronaria, Hospital La Paz, Paseo de la Castellana 261, 28046-Madrid, Spain
Abstract
To calculate the accuracy of dobutamine infusion as a stress test to detect coronary lesions, 90 patients with angina and nine asymptonlatic subjects with nonsignificant coronary lesions were submitted to a dobutamine test and coronary arteriography. Dobutamine was given in doses of 5, 10, 15 and 20µg kg–1 min–1 every 5 min; a 12 lead ECG and blood pressure was monitored. Pressurexrate product increased from 8240±1667 to 14898±3042. The test was negative (neither angina pain, nor ST seginent shift) in 31 patients, and positive in 68. The ST segment was depressed in 33 cases and elevated in 20. Significant (
50%) coronary lesions were seen in 63 patients and functional (coronary spasm or vasoconstriction) abnormalities in six. The sensitivity of the dobutamine test for the detection of coronary lesions was 95%, specificity 78%, predictive value of a positive test 88%, of a negative test 90% and diagnostic efficiency 89%. Strongly positive tests predictedsevere lesions in 91% of the cases, and slightly positive tests ruled out severe lesions in 84%. ST segment elevation was induced in 20 cases and corresponded to a severe coronary lesion. In conclusion, the dobutamine stress test is a simple and accurate method of predicting coronary artery disease in patients with angina, distinguishing between severe and mild lesions. It can be a good alternative to an exercise test.
Key Words: Dobutamine test • angina • stress test • coronary artery disease
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