Clinical Utility of Digital Dobutamine Stress Echocardiography in the Noninvasive Evaluation of Coronary Artery Disease

Abstract

Exercise electrocardiography is an established mode of evaluation for patients with suspected coronary artery disease. It also provides prognostic information and guides therapeutic management in patients with established disease. However, some patients are unable to exercise because of orthopedic problems, neurologic diseases, peripheral vascular disease, or deconditioning. In the past, these patients have been referred for angiography to help assess their disease. Recently, however, new techniques to assess myocardial perfusion and/or function, including stress echocardiography, have been used in the noninvasive assessment of coronary artery disease in this group of patients. Echocardiography has been used in combination with different drugs, including dobutamine, dipyridamole, and adenosine. Dobutamine is probably the single most studied drug for stress echocardiography. Dobutamine stress echocardiography is a safe, feasible, and valuable technique for evaluating coronary artery disease.

Diagnostic Value of Dobutamine Stress Echocardiography in Patients With Normal Wall Motion at Rest

“…Compared to previously published reviews on the diagnostic accuracy of DSE including patients with and without resting WMA 1–3 the weighted mean sensitivity for the detection of CAD in our analysis in patients without resting WMA is relatively low. Several factors such as the clinical characteristics of the patients studied (severity and extent of CAD, use of beta‐blockers), stress protocol (addition of atropine), threshold for defining significant CAD (50% or 70%), and definition of a positive test (dobutamine stress‐induced or any WMA) may influence the sensitivity of DSE 27 .…”

“…In reviews on the diagnostic value of DSE comparable weighted mean sensitivities (ranging from 80% to 85%) and specificities (ranging from 83% to 86%) for the detection of CAD were reported 1–3 . Most studies included in these reviews included heterogeneous patients of whom many had wall motion abnormalities (WMA) at rest.…”

Sustained Nonischemic Ventricular Tachycardia during Dobutamine Stress Echocardiography

“…Exercise treadmill stress testing with or without con comitant functional or physiologic imaging has become widely recognized as a very useful tool in the evaluation or detection of coronary artery disease [8], Its application, however, is limited in those patients with orthopedic, neu rologic and peripheral vascular disease or in those patients unable to exercise adequately due to deconditioning or oth er concomitant illness [2], In these patients, therefore, dobutamine stress echocardiography and other forms of pharmacologic stress testing have emerged as viable alter natives to treadmill exercise tolerance test [1][2][3][4][5][6][7],…”

“…Graded infusion of dobutamine was administered using a stan dard protocol [2]. The patient experienced no symptoms and exhib ited normal hemodynamic response (table 1).…”

“…Digital dobutamine stress echocardiography has been shown to be a safe and effective means of evaluating patients with known or suspected coronary artery disease [1][2][3]. Its utility is also proven in the assessment of myo cardial tissue viability [4], efficacy of thrombolytic thera py [5] and coronary artery revascularization [6,7], While ventricular ectopic complexes, supraventricular arrhyth mias and less frequently nonsustained ventricular tachy cardia are often encountered during dobutamine stress echocardiography, sustained ventricular tachycardia in the absence of coronary artery disease or cardiomyopathy has not yet been reported.…”