Stress echocardiography: Comparison of exercise, dipyridamole and dobutamine in detecting and predicting the extent of coronary artery disease

Abstract

In a clinical setting, exercise echocardiography should represent the first diagnostic approach because it has high diagnostic efficacy and provides additional information on exercise capacity; pharmacologic stress, particularly that of dobutamine, provides a pivotal diagnostic tool when exercise is not feasible or its results are nondiagnostic. Our preliminary data on echocardiographic evaluation at ischemic threshold support the view that myocardial contractility is a major factor in inducing ischemia during dobutamine infusion.

II Diretriz de Avaliação Perioperatória da Sociedade Brasileira de Cardiologia

“…Dobutamine and exercise stress echocardiographies present similar diagnostic accuracies and are more accurate than dipyridamole stress echo 48 . If dobutamine stress echo does not reveal the presence of residual ischemia in a patient with a history of myocardial infarction, the prognosis is good and the likelihood of another myocardial infarction is low in the perioperative period of a noncardiac surgery 33 .…”

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

“…The maximal double product representing MVO 2 was also greater with exercise than with dobutamine. 20 Although dobutamine echocardiography seems to be quite safe, frequency of side effects observed with exercise echo was lower ( Table 3). The comparison may be made to the study of Elhendy et al 15 comprising a group of 446 hypertensive patients in which the maximal dose of dobutamine (36 Ϯ 7 g/kg/min) and use of atropine (42% patients) were almost the same as in the present study.…”

<b>Dipyridamole Stress Echocardiography and Ultrasonic Myocardial Tissue Characterization in Predicting Myocardial Ischemia, in Comparison With Dipyridamole Stress Tc-99m MIBI SPECT Myocardial Imaging</b>

“…[13][14][15][16][17] Dagianti, et al and Casanova, et al showed that the sensitivity of dipyridamole stress echocardiography was 52% and 53%, respectively. 18,19) However, the specificity of dipyridamole echocardiography has been reported to be excellent even in challenging subsets of patients in whom the rate of false-positive responses was higher with electrocardiographic or scintigraphic techniques, such as hypertensive patients. 20) In a pooled analysis of data from 11 published series, the sensitivity and specificity of dipyridamole scintigraphy for CAD detection averaged 85% and 90%, respectively.…”