Comparison of Arbutamine and Exercise Echocardiography in Diagnosing Myocardial Ischemia (original) (raw)
Related papers
Heart, 1994
Objective-To compare the ability of dobutamine and exercise stress to induce myocardial ischaemia and perfusion heterogeneity under routine clinical circumstances. Design-86 active patients without previous myocardial infarction were studied by dobutamine and exercise stress protocols and coronary angiography. During both tests patients underwent electrocardiography, digitised echocardiography, and perfusion scintigraphy using Tc-99m methoxybutylisonitrile (MIBI) single photon emission computed tomography. Main outcome measure-Coronary disease defined as an ST segment depression of > 0-1 mV, a resting or stress induced perfusion defect, or a resting or stress induced wail motion abnormality on exercise and dobutamine stress testing. Results-Dobutamine stress was submaximal in 51 patients because of ingestion of f adrenoceptor blocking agents on the day of the test (n = 25) or failure to attain the peak dose owing to side effects (n = 28). Exercise was limited in. 23 patients by non-cardiac symptoms. The peak heart rate with dobutamine was less than that attained with exercise (105 (25) v 132 ( 24) beatslmin, P < 0.0001); the response to maximal dobutamine stress significantly exceeded that to submaximal stress. Peak blood pressure was greatest with exercise mm Hg, P < 0.001), values at maximal and submaximal dobutamine stress being comparable. Electrocardiographic evidence of ischaemia was induced less frequently by dobutamine than exercise (32% v 77% of the 56 patients with significant coronary disease, P < 0.01), as was abnormal wail motion (54% v 88%, P < 0.001). Ischaemia was induced more readily with maximal stress of either type; thus the sensitivities of dobutmine and exercise echocardiography were comparable only in patients undergoing a maximal dobutamine testing (73% v 77%, NS). Perfusion heterogeneity was induced in 58% of patients with coronary disease at submaximal dobutamine stress, 73% at maximal dobutamine stress, and 73% at exercise stress (NS). Among 30 patients without coronary stenoses, normal function was obtained in 83% of echocardiography studies with dobutamine and in 80%/o with exercise (NS). Normal perfusion was identified in 70%/o of these patients at exercise MIBI, and 68% at dobutamine stress (NS).
Heart (British Cardiac Society), 2000
To determine whether pharmacological stress leads to prolonged but reversible left ventricular dysfunction in patients with coronary artery disease, similar to that seen after exercise. A randomised crossover study of recovery time of systolic and diastolic left ventricular function after exercise and dobutamine induced ischaemia. 10 patients with stable angina, angiographically proven coronary artery disease, and normal left ventricular function. Treadmill exercise and dobutamine stress were performed on different days. Quantitative assessment of systolic and diastolic left ventricular function was performed using transthoracic echocardiography at baseline and at regular intervals after each test. Both forms of stress led to prolonged but reversible systolic and diastolic dysfunction. There was no difference in the maximum double product (p = 0.53) or ST depression (p = 0.63) with either form of stress. After exercise, ejection fraction was reduced at 15 and 30 minutes compared wit...
The dobutamine stress test as an alternative to exercise testing after acute myocardial infarction
Heart, 1988
Three weeks after myocardial infarction in 50 patients the effect of the infusion of a graded dose of dobutamine was compared with that of symptom limited treadmill exercise testing. The following variables were measured: blood pressure, heart rate, ST segment changes, Doppler aortic blood flow, and cross sectional echocardiographic dimensions. The heart rate and double product increased more-during exercise than during dobutamine infusion, while maximum acceleration in the ascending aorta increased more during dobutamine infusion than during exercise. Significant ST depression was recorded in 22 patients during exercise and in 24 during dobutamine infusion; the concordance between the two tests was 88%. In all cases in which ST segment depression occurred in both tests the site of ST depression was the same. Dobutamine stress testing is an alternative to exercise testing in patients after myocardial infarction.
Journal of Electrocardiology, 1997
Exercise testing after acute myocardial infarction is commonly used, but in recent years alternative methods have been proposed. Standard exercise testing was compared with dobutamine electrocardiographic (ECG) stress testing in 100 patients after an acute initial myocardial infarction. Dobutamine ECG stress testing was performed in a standard manner at 5 + 1 days after the infarction and exercise testing was performed a mean of 10 + 2 days following the event. Agreement between both tests was observed in 91 cases (91%), P < .001, Fisher test kappa value, 0.79). The dobutamine test predicted the result of the exercise test with a sensitivity of 100% (95% confidence interval, 87-100) and a specificity of 88% (95% confidence interval 77-93) for a positive predictive value of 75% (95% confidence interval, 62-97) and a negative predictive value of 100% (95% confidence interval, 91-100). Dobutamine ECG stress testing is concluded to be an objective and reliable procedure, which accurately predicts the results of standard exercise testing. Iris inexpensive, easy to perform, and although not yet confirmed, could be particularly useful in patients who cannot perform exercise.
The American Journal of Cardiology, 1999
Several stress echocardiography (SE) modalities have been introduced for diagnosing coronary artery disease (CAD). Exercise and dobutamine SE are considered to have better diagnostic accuracy than vasodilator or isometric SE, but there are no studies in a single group of patients comparing these 3 tests with heavy 2-arm isometric SE. The purpose of this study was to determine the diagnostic characteristics of 4 SE methods in patients with chest pain. Altogether, 60 patients (age ؎ SD 55.1 ؎ 2.1 years) were tested with bicycle, heavy 2-arm isometric, dipyridamole-atropine and dobutamine SE. CAD (>50% stenosis) was present in 44 patients; 26 patients had 1-vessel disease. During bicycle SE, the double product at peak stress was higher than during dobutamine and dipyridamole-atropine SE (26.5 ؋ 10 3 , p <0.005 vs dobutamine and dipyridamole-atropine SE), and peak wall motion score index (1.40) was higher than during dipyridamole-atropine and isometric SE (1.26 and 1.07, respectively, p <0.05 vs bicycle SE). Bicycle , dipyridamole-atropine, and dobutamine SE had higher sensitivity than isometric SE (90%, 93%, 95%, and 30%, respectively, p <0.05 isometric SE vs others). There were no statistically significant differences with regard to specificity. Similarly, bicycle, dipyridamoleatropine, and dobutamine SE had a higher diagnostic accuracy than isometric SE (78%, 88%, 87% and 47%, respectively, p <0.05 isometric SE vs others). We conclude that bicycle, dipyridamole-atropine, and dobutamine SE have an equal diagnostic accuracy in detecting CAD despite higher double product and ischemic burden at peak stress during bicycle and dobutamine SE over dipyridamole-atropine SE. Heavy isometric SE is inaccurate.