Dobutamine stress echocardiography: Angiographic correlates

Abstract

We started a dobutamine stress echocardiography (DSE) programme in September 1992. Until January 1994, we had performed 300 such procedures. Of these patients, 81 underwent cardiac catheterisation within 6 months of DSE without a cardiac event in the interim. Eleven DSEs were performed to assess myocardial viability and another 6 were inconclusive for myocardial ischaemia. The remaining 64 were correlated with the angiographic data to determine the utility of this technique in our institution. The mean age of the cohort was 57 years. Thirty-six patients were referred for DSE in the workup for chest pain, either anginiform (22) or atypical (14). Fourteen patients had a recent (6) or remote (8) myocardial infarction. Thirteen patients were asymptomatic. Significant obstructive coronary artery disease (CAD) was identified in 36 patients of whom 17 and 19 had single and multivessel disease respectively. The sensitivity of DSE in the entire cohort was 89% and the spectificity 82%. Positive and negative predictive values of DSE were 86% and 85% respectively. Although the numbers involved were small, sensitivity figures for single and multivessel disease were 94% and 84% respectively. Of the patients with single vessel CAD, prediction of the artery involved by presumed territorial supply was accurate in 81%. DSE is a highly accurate tool for evaluating CAD, identifying both the patient with CAD and the location of disease.