Author + information
- Received September 7, 1996
- Revision received April 26, 1997
- Accepted May 16, 1997
- Published online July 1, 1997.
- Marcel L. Geleijnse, MDA,*,
- Paolo M. Fioretti, MD, PhD, FACCA and
- Jos R.T.C. Roelandt, MD, PhD, FACCA
- ↵*Dr. Marcel L. Geleijnse, Thoraxcentre, Ba 302, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
Large numbers of patients referred for evaluation of chest pain are unable to perform adequate, diagnostic exercise testing. In these patients, dobutamine stress echocardiography (DSE) represents an alternative, exercise-independent stress modality. Apart from the ∼5% of patients with an inadequate acoustic window, 10% of patients referred for this test have nondiagnostic (submaximal negative) test results. Serious side effects during or shortly after DSE are uncommon, with ventricular fibrillation or myocardial infarction occurring in ∼1 of 2,000 studies. No deaths have been reported. On the basis of a total number of 2,246 patients, reported in 28 studies, the sensitivity, specificity and accuracy of the test for the detection of coronary artery disease (CAD) were 80%, 84% and 81%, respectively. Mean sensitivities for one-, two- and three-vessel disease were 74%, 86% and 92%, respectively. The sensitivity for detection of disease in the left circumflex coronary artery (55%) was lower, both compared with that for left anterior descending (72%) and right coronary artery disease (76%). The sensitivity of predicting multivessel disease by multiregion echocardiographic abnormalities varied widely, from 8% to 71%. In direct comparisons, DSE was superior to exercise electrocardiography and dipyridamole echocardiography and comparable to exercise echocardiography and radionuclide imaging. DSE is a useful, feasible and safe exercise-independent stress modality for assessing the presence, localization and extent of CAD.
☆ This work was supported in part by Grant NHS 94.135 from the Dutch Heart Foundation, The Hague, The Netherlands.
- Received September 7, 1996.
- Revision received April 26, 1997.
- Accepted May 16, 1997.