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

Abstract

dobutamine stress echocardiography, coronary artery disease, diagnosisA 45-year-old female presented to our outpatient clinic with a 4-month history of exerciserelated midsternal pressure, lasting for 10 minutes. Risk factors for cardiovascular disease included smoking and a LDL level of 3.1 mmol/L. Because of the intermediate pretest probability for coronary artery disease (CAD) and inability to perform bicycle stress testing, dobutamine stress echocardiography (DSE) was performed. During this test target heart rate was reached and left ventricular wall motion was normal at rest and peak stress. The treating physician concludes that CAD was not present and the patient was discharged from further follow-up. Three months later the patient was diagnosed with a non-ST-elevation acute coronary syndrome. Coronary angiography revealed a 80% diameter stenosis of the left anterior descending coronary artery.The purpose of this article is to answer the question whether the physician's impression on the low probability of CAD in this patient was correct.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. Because in these latter patients CAD is

Cardiac risk evaluation for abdominal transplantation

“…However, test results diverge when drugs are used to increase oxygen consumption [21]. With dobutamine, echocardiography is less sensitive but more specific than perfusion imaging [21], and b-agonists are better than vasodilators such as adenosine or dipyridamole for inducing ischemia with either technique [22].…”

Échographie de stress

“…Aux limites initiales qui portaient essentiellement sur la qualité de l'image, en grande partie corrigée par l'avènement de l'imagerie d'harmonique et l'utilisation du contraste intracavitaire (16), se sont substituées des limites liées soit au type de protocole (17), soit aux modalités (18) et aux indications de l'examen, soit encore à l'interprétation des résultats en fonction de la technique de réfé-rence utilisée (19). L'angiographie coronaire reste la méthode de référence, pour ce qui concerne la défi nition morphologique du degré de signifi cativité d'une sté-nose coronaire mais tant la scintigraphie que l'échographie de stress a l'ambition de documenter l'ischémie, son territoire et donc l'artère responsable de celle-ci.…”

Prediction of coronary artery stenosis using strain imaging diastolic index at rest in patients with preserved ejection fraction

“…Echocardiographic detection of coronary artery disease usually requires stress tests because visible systolic dysfunction is not always evident at rest, unless myocardial infarction is present [1][2][3]. Recently, use of strain imaging derived from 2D speckle tracking analysis has been validated for quantitative evaluation of regional wall motion abnormalities in ischemic heart disease [4][5][6].…”