Stress echocardiography in the detection of myocardial ischemia. Head-to-head comparison of exercise, dobutamine, and dipyridamole tests.

Beleslin, Branko; Ostojić, Miodrag; Stepanović, Jelena; Djordjevic‐Dikic, Ana; Stojković, Siniša; Nedeljković, Milan; Stanković, Goran; Petrasinovic, Zorica; Gojkovic, L; Vasiljevic-Pokrajcic, Zorana

doi:10.1161/01.cir.90.3.1168

Cited by 275 publications

(107 citation statements)

References 34 publications

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“…There is a trend toward a greater sensitivity of dobutamine (79 vs. 72%) and a slightly higher specificity of dipyridamole (94 vs. 88%). Results obtained in our work are similar to those found by us 20 and other investigators 21,22 who have compared DOBE and DIPE in a general population. A recently published meta-analysis comparing both tests further supports our findings.…”

Section: Discussionsupporting

confidence: 92%

Dobutamine stress echocardiography in the diagnosis of coronary artery disease in women with chest pain: Comparison with different noninvasive tests

Rollán

Román

Vilacosta

et al. 2002

Clinical Cardiology

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SummaryBackground: Diagnosis of coronary artery disease (CAD) in women remains elusive. The classical diagnostic armamentarium has been found to be very limited. Dobutamine stress echocardiography has emerged as a powerful test in assessing CAD in the general population, but most studies failed to include women.Hypothesis: The accuracy of dobutamine stress echocardiography in the diagnosis of CAD in women with chest pain is high and superior to dipyridamole echocardiography, exercise electrocardiography, and sestamibi single-photon emission tomography (MIBI-SPECT) scintigraphy.Methods: We studied 99 consecutive women with chest pain and no previous history of CAD who underwent dobutamine echocardiography and coronary angiography. We also compared these results with those of dipyridamole echocardiography in 63 patients, exercise stress testing in 83 (48 conclusive), and MIBI-SPECT scintigraphy during dobutamine infusion in 54.Results: Significant CAD was found in 42 women. Sensitivity and specificity of dobutamine stress echocardiography were 69 and 89%, respectively. Dipyridamole echocardiogra-

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Section: Discussionsupporting

confidence: 92%

Dobutamine stress echocardiography in the diagnosis of coronary artery disease in women with chest pain: Comparison with different noninvasive tests

Rollán

Román

Vilacosta

et al. 2002

Clinical Cardiology

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“…First, identification of stress-induced WMAs is a well-accepted and specific marker of ischemia, and vasodilators appear to be less sensitive than dobutamine or exercise stress for inducing WMAs during stress echocardiography. 17 This difference is likely related to the dependence of WMAs on increased myocardial oxygen demand rather than "coronary steal" or reduced aortic pressure. 18 Second, the selection of vasodilator stress echocardiography in patients who would otherwise be able to exercise necessarily relinquishes valuable information relating to exercise capacity, correlation of symptoms with exercise, and ST-segment changes.…”

Section: Dipyridamole-exercise Stressmentioning

confidence: 99%

Incremental Benefit of Myocardial Contrast to Combined Dipyridamole-Exercise Stress Echocardiography for the Assessment of Coronary Artery Disease

et al. 2004

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Background-Although assessment of myocardial perfusion by myocardial contrast echocardiography (MCE) is feasible, its incremental benefit to stress echocardiography is not well defined. We examined whether the addition of MCE to combined dipyridamole-exercise echocardiography (DExE) provides incremental benefit for evaluation of coronary artery disease (CAD). Methods and Results-MCE was combined with DExE in 85 patients, 70 of whom were undergoing quantitative coronary angiography and 15 patients with a low probability of CAD. MCE was acquired by low-mechanical-index imaging in 3 apical views after acquisition of standard resting and poststress images. Wall motion, left ventricular opacification, and MCE components of the study were interpreted sequentially, blinded to other data. Significant (Ͼ50%) stenoses were present in 43 patients and involved 69 coronary territories. The addition of qualitative MCE improved sensitivity for the detection of CAD (91% versus 74%, Pϭ0.02) and accurate recognition of disease extent (87% versus 65% of territories, Pϭ0.003), with a nonsignificant reduction in specificity. Conclusions-The addition of low-mechanical-index MCE to standard imaging during DExE improves detection of CAD and enables a more accurate determination of disease extent.

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“…12,19,20 Previous dobutamine stress studies have shown that as a net result, in general, there is a mild but significant increase in systolic BP. 6,21 This would suggest that, on average, an increase in cardiac output corrects for the decrease in systemic vascular resistance. Although the pathophysiology of hypotension during dobutamine infusion has not been completely de- Variables included in the model were the patient characteristics of Table I, an increase in systolic BP, and fixed and reversible perfusion defects.…”

Section: Resultsmentioning

confidence: 99%

Prognostic Significance of Systolic Blood Pressure Changes During Dobutamine-Atropine Stress Technetium-99m Sestamibi Perfusion Scintigraphy in Patients With Chest Pain and Known or Suspected Coronary Artery Disease

Geleijnse

Elhendy

Domburg

et al. 1997

The American Journal of Cardiology

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To investigate the prognostic value of dobutamine stressinduced changes in systolic blood pressure (BP) 418 patients (mean age 60 years, 238 men) with chest pain and known or suspected coronary artery disease, who underwent a dobutamine-atropine stress technetium99m sestamibi myocardial perfusion scintigraphic study, were followed up for 25 { 15 months. Blood pressure was measured by automatic sphygmomanometry every 3 minutes. A marked decrease and increase in systolic BP from rest to peak were defined as changes of ¢20 mm Hg, and ¢30 mm Hg, respectively. Worst outcome events were cardiac death (n Å 30), nonfatal myocardial infarction (n Å 17), and hospitalization for congestive heart failure (n Å 8). A decrease in systolic BP (prevalence 16%) was associated with older age and higher baseline systolic BP. Fixed and reversible sestamibi perfusion defects and follow-up results were similar to patients without a systolic BP decrease. In contrast, an increase in systolic BP (prevalence 24%) was associated with younger age, lower baseline systolic BP, and with absence of a history of prior congestive heart failure or treatment with angiotensin-converting enzyme inhibitors. Furthermore, these patients had fewer fixed perfusion defects and tended to have fewer annual event rates (3.5% vs 7.5%, p õ0.10). In a multivariate model, an increase in systolic BP was not an independent predictor for subsequent events. In conclusion, a dobutamine-induced decrease in systolic BP is not associated with fixed or reversible sestamibi defects or adverse prognosis. An increase in systolic BP, however, is associated with less fixed sestamibi defects and a tendency toward less annual event rates. ᮊ1997 by Excerpta Medica, Inc.(Am J Cardiol 1997;79:1031-1035) D obutamine stress technetium-99m sestamibi myocardial perfusion scintigraphy is a pharmacologic stress modality with diagnostic 1-5 and prognostic 6 properties comparable to dobutamine stress echocardiography. Previous dobutamine stress echocardiographic studies have reported that dobutamine stress-induced hypotension is -unlike exercise -induced hypotension 7 -10 not related to new or worsening wall motion abnormalities 11 -14 and the presence or extent of coronary artery disease. 11,12Furthermore, a relatively small echocardiographic study 12 has supported these results with prognostic data that were similar for the hypotensive and the nonhypotensive group. To date, however, these findings were not confirmed by myocardial perfusion scintigraphic data. Also, it is not known whether a substantial increase in systolic blood pressure (BP)From the Thoraxcentre and the Department of Nuclear Medicine, University Hospital, Rotterdam-Dijkzigt and Erasmus University, Rotterdam, The Netherlands. This study was supported in part by funds from the Dutch Heart Foundation (Grant NHS 94.135), The Hague, The Netherlands, and Cairo University Hospital, Cairo, Egypt. Manuscript received July 16, 1996; revised manuscript received and accepted December 12, 1996.Address for reprints: Marcel L. Geleijn...

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Stress echocardiography in the detection of myocardial ischemia. Head-to-head comparison of exercise, dobutamine, and dipyridamole tests.

Cited by 275 publications

References 34 publications

Dobutamine stress echocardiography in the diagnosis of coronary artery disease in women with chest pain: Comparison with different noninvasive tests

Dobutamine stress echocardiography in the diagnosis of coronary artery disease in women with chest pain: Comparison with different noninvasive tests

Incremental Benefit of Myocardial Contrast to Combined Dipyridamole-Exercise Stress Echocardiography for the Assessment of Coronary Artery Disease

Prognostic Significance of Systolic Blood Pressure Changes During Dobutamine-Atropine Stress Technetium-99m Sestamibi Perfusion Scintigraphy in Patients With Chest Pain and Known or Suspected Coronary Artery Disease

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