[Dobutamine stress echocardiography in symptomatic patients with non-diagnostic or negative treadmill test]

In patients suffering from angina like exertional pain or dyspnea with a negative or undiagnosed exercise treadmill test (u/n TET), controversy exists regarding indications to perform coronary angiography. This study was performed in order to evaluate the diagnostic significance of dobutamine echo-stress (DSE) in assessing the possible causes of symptoms in such patients. We retrospectively analysed 550 patients. Out of this number, 128 patients had a u/nTET (study group--SG) and 422 patients had a positive TET--control group (CG). The exercise treadmill test was performed according to the Bruce protocol. Dobutamine stress echocardiography was performed according to a standard protocol.

In patients that were DSE(+), no significant differences in the analysed parameters were found between study and control groups. In patients that were DSE(-), monovariate analysis detected that gender, age, history of hypertension, LVH, sigmoid IVS, small LV and EF as factors predicting clinical symptoms. Multivariate analysis revealed that middle-aged women, elderly men, and history of hypertension were independent predictors of exertional symptoms. Multivariate analysis also showed that intracavitary LV obstruction or LV outflow tract obstruction in hypertensive females was an independent predictor of reproducibility of symptoms.

1. Angina-like symptoms in patients with non-diagnostic/negative TET and negative DSE depends on several clinical and echocardiographic factors. 2. Dynamic intracavitary LV obstruction or LV outflow tract obstruction, especially with a hypotensive reaction, are potential causes of symptoms in patients with non-diagnostic/negative TET and negative DSE. 3. Reproducibility of symptoms during negative DSE occurred in hypertensive females with dobutamine-induced intracavitary LV obstruction or LV outflow tract obstruction.