Dipyridamole echocardiography in essential hypertensive patients with chest pain.

Abstract

SUMMARYThe exerdse-electrocardiography test shows limited feasibility and diagnostic accuracy for the ooninvaslve detection of coronary artery disease hi hypertensive patients. Recently, the dipyridamoleechocardiography test (two-dimensional echocardtographic monitoring with dipyridamole infusion, up to 0.84 mg/kg over 10 minutes) has been proposed as an exercise-independent method for the diagnosis of coronary artery disease. The diagnostic usefulness of the exerdse-electrocardiography test and the dipyridamole-echocardiography test was evaluated in 63 consecutive inpatients with history of chest pain, essential hypertension, and no previous myocardial infarction. The criterion of posltlvity for the exerdse-electrocardiography test was a horizontal or downsioping ST segment shift exceeding 0.1 mV and for the dipyridamole-echocardiography test, a transient dyssynergy of contraction. Fifteen patients could not perform a diagnostic exerdse-electrocardiography test because of an nubility to exercise adequately (two patients), severe hypertension hi spite of full antihypertensive therapy (six patients), or excessive blood pressure rise at the first step of the exercise-electrocardiography test (seven patients). Five patients could not perform the dipyridamole-echocardiography test because of a poor acoustic window. The overall feasibility was 76% for the exercise-electrocardiography test and 92% for the dipyridamoleechocardiography test (p < 0.05). All 43 patients who performed both tests underwent coronary angiography; 30 had significant coronary artery disease (>70% lumen reduction of at least 1 major coronary vessel). Sensitivity was 67% for both the exercise-electrocardiography test and the dipyridamoleechocardiography test (p = NS); spedfidty was 46% for the exerdse-electrocardiography test and 92% for the dipyridamole-echocardiography test {p < 0.05). Thus, the dipyridamole-echocardiography test represents a good diagnostic alternative to the exercise-electrocardiography test hi symptomatic hypertensive patients, as it has a similar sensitivity and higher feasibility and spedfidty for the detection of coronary artery disease.

Advantages of exercise echocardiography in comparison to dobutamine echocardiography in the diagnosis of coronary artery disease in hypertensive subjects

“…Picano et al 2 found that in hypertensive patients, sensitivity of dipyridamol echocardiography and exercise ECG were the same (67%) but specificity of echocardiography was markedly better (92% vs 46%, P Ͻ 0.05). Senior et al 3 found that in patients with hypertension dobutamine echocardiography was more specific (100% vs 29%, P Ͻ 0.005) as well as more sensitive (93% vs 72%, P = NS) than exercise ECG.…”

“…Several reports emphasise the lower specificity of exercise ECG stress test in patients with elevated blood pressure when compared to normotensive subjects. 2,4 Tsuda et al 4 have shown that specificity of ECG stress test was significantly higher in normotensive patients than in hypertensive patients (67% vs 52%). Similar observations emphasising the higher specificity of exercise ECG in patients with…”

“…Differences between diagnostic methods were compared with Student's t-test for paired comparisons or Wilcoxon Cox test. Categorical data were compared either with 2 or with McNemar test when efficacy of diagnostic methods was compared. P values of Ͻ0.05 were considered to be significant.…”

“…Because of the high rate of false-positive results the positive predictive value of electrocardiographic (ECG) exercise test is low. [2][3][4][5] For the last 10 years stress echocardiography has been developed as the more specific method of diagnosing coronary artery disease than exercise ECG. Efficacy of stress echocardiography has been proved in small groups of hypertensive patients.…”

“…Efficacy of stress echocardiography has been proved in small groups of hypertensive patients. 2,3 Echocardiography may be coupled with different stress methods although most popular are physical exercise and infusion of high doses of dobutamine. Efficacy of different stress echocardiographic methods in hypertensive subjects has so far not been compared.…”