Copyright © 2003 by the European Society of Cardiology.
Regular Articles
Non-invasive diagnosis of coronary artery disease by quantitative stress echocardiography: optimal diagnostic models using off-line tissue Doppler in the MYDISE study
a University of Wales College of Medicine, Cardiff, UK
b University Hospital Benjamin Franklin, Berlin, Germany
c Hôpital Saint Antoine, Paris, France
d Hôpital Charles Nicolle, Rouen, France
e University Hospital Sart Tilman, Liège, Belgium
f University Hospital, Linköping, Sweden
g Huddinge University Hospital, Stockholm, Sweden
* Author for correspondence. Dr Alan G. Fraser, Wales Heart Research Institute, University of Wales College of Medicine, Heath Park, CardiffCF14 4XN, Wales, UK. Tel.: +44-2920-743489; fax: +44-2920-743500
E-mail address: fraiserag{at}cf.ac.uk
Received 10 October 2002; revised 2 December 2002; accepted 11 December 2002
Aims To develop optimal methods for the objective non-invasive diagnosis of coronary artery disease, using myocardial Doppler velocities during dobutamine stress echocardiography.
Methods and results We acquired tissue Doppler digital data during dobutamine stress in 289 subjects, and measured myocardial responses by off-line analysis of 11 left ventricular segments. Diagnostic criteria developed by comparing 92 normal subjects with 48 patients with coronary disease were refined in a prospective series of 149 patients referred with chest pain. Optimal diagnostic accuracy was achieved by logistic regression models, using systolic velocities at maximal stress in 7 myocardial segments, adjusting for independent correlations directly with heart rate and inversely with age and female gender (all p<0.001). Best cut-points from receiver-operator curves diagnosed left anterior descending, circumflex and right coronary disease with sensitivities and specificities of 80% and 80%, 91% and 80%, and 93% and 82%, respectively. All models performed better than velocity cut-offs alone (p<0.001).
Conclusion Non-invasive diagnosis of coronary artery disease by quantitative stress echocardiography is best performed using diagnostic models based on segmental velocities at peak stress and adjusting for heart rate, and gender or age.
Key Words: Stress echocardiography • Tissue Doppler • Dobutamine
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