Copyright © 1992 by the European Society of Cardiology.
© 1992 The European Society of Cardiology
Pharmacological stress echocardiography in the diagnosis of coronary artery disease and myocardial ischaemia: a comparison between dobutamine and dipyridamole
Thoraxcenter, University Hospital Rotterdam-Dijkzigt and Erasmus University Rotterdam, The Netherlands
Received 9 October 1991; revised 28 February 1992; .
Correspondence Paolo Fioretti, Thoraxccnlcr. Ba 300, Erasmus University Rotterdam. P.O. Box 1738. 3000 DR Rotterdam. The Netherlands
Abstract
The objective of this study was to relate regional wall motion abnormalities assessed by dobutamine and dipyridamole stress echocardiography to quantitative measurements of coronary artery stenoses in consecutive patients referred for coronary angiography, and to compare haemodynamic effects of and complications related to the two agents.
Patients underwent stress echoes on separate days in random sequence and had coronary angiography within 3 days of stress echocardiography. Echocardiograms were assessed by two investigators unaware of the patients coronary anatomy. Coronary angiograms were also assessed quantitatively using the computer-assisted Cardiovascular Angiography Analysis System.
There were 46 consecutive patients referred for coronary angiography; 28 were using ß-antagonists.
Main outcome measures were sensitivity and specificity for dobutamine and dipyridamole stress echocardiography for detection of coronary artery disease ( wall motion abnormalities at rest or stress) andmyocardial ischaemia (stress induced new wall motion abnormalities).
Sensitivity for the detection of myocardial ischaemia was found to be 57% for dobutamine and 64% for dipyridamole. Specificities were 78% and89% respectively. Sensitivitiesfor detection of coronary artery disease (lesion
50% diameter stenosis) was 79% for dobutamine and 82% for dipyridamole; specificities were 78% and 89% respectively. These differences between the two agents are not significant. There were no severe side effects with either agent. Mean heart rate rose significantly with both tests but was higher with dobutamine; mean systolic blood pressure rose with dobutamine and fell with dipyridamole.
It was concluded that dobutamine and dipyridamole stress echocardiography have similar sensitivities and specificities for detection of myocardial ischaemia and coronary artery disease although the haemodynamic effects of the two agents are different. Both are free from serious complications.
Key Words: Stress echocardiography • dobutamine • dipyridamole
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