Transesophageal dipyridamole echocardiography for diagnosis of coronary artery disease
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Transesophageal dipyridamole echocardiography is a viable alternative for assessing coronary artery disease when transthoracic views are poor. This stress test demonstrated high sensitivity and specificity in identifying significant coronary artery obstructions.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Pharmacology
Background:
- Transthoracic dipyridamole echocardiography is a standard diagnostic tool.
- A poor acoustic window can limit transthoracic echocardiography feasibility.
- Transesophageal echocardiography offers an alternative when transthoracic imaging is not optimal.
Purpose of the Study:
- To evaluate the efficacy of transesophageal echocardiography with high-dose dipyridamole for diagnosing coronary artery disease.
- To assess the feasibility and safety of this transesophageal stress test.
Main Methods:
- 32 patients with suboptimal transthoracic windows or ambiguous results underwent transesophageal echocardiography with high-dose dipyridamole (0.84 mg/kg).
- Coronary angiography was performed in all patients to define significant coronary artery disease (≥70% lumen narrowing).
- Bicycle exercise tests were conducted prior to the transesophageal stress study.
Main Results:
- Transesophageal dipyridamole echocardiography was successfully completed in all patients with no reported side effects.
- High-quality images were consistently obtained, allowing visualization of the left ventricle.
- The test demonstrated 100% specificity and 92% overall sensitivity for detecting coronary artery disease.
- Sensitivity for single-, double-, and triple-vessel disease was 67%, 100%, and 100%, respectively.
Conclusions:
- Transesophageal dipyridamole echocardiography is a safe and effective method for diagnosing coronary artery disease.
- It is particularly useful in patients with poor acoustic windows for transthoracic imaging.
- The test provides accurate assessment of significant coronary artery obstructions.
Abstract:
The value of transthoracic dipyridamole echocardiography has been extensively documented. However, in some patients, because of a poor acoustic window, the rest transthoracic examination is not always feasible and the transesophageal approach is more convenient. Therefore, transesophageal echocardiography with high dose dipyridamole (up to 0.84 mg/kg body weight over 10 min) was performed in 32 patients in whom the transthoracic dipyridamole test either was not feasible (n = 29) or yielded ambiguous results (n = 3). The transesophageal echocardiographic test results were considered abnormal when new dipyridamole-induced regional wall motion abnormalities were observed. All 32 patients underwent coronary angiography; significant coronary artery disease was defined as greater than or equal to 70% lumen diameter narrowing in at least one major vessel. All patients also performed a bicycle exercise test 1 day before transesophageal dipyridamole echocardiography. Transesophageal stress studies were completed in all patients, with a maximal imaging time (in tests with a negative result) of 20 min. No side effects or intolerance to drug or transducer was observed. The left ventricle was always visualized in the four-chamber and transgastric short-axis views. High quality two-dimensional echocardiographic images were obtained in all patients both at rest and at peak dipyridamole infusion and were digitally analyzed in a quad-screen format. Coronary angiography showed coronary artery obstruction in 24 patients: 6 had single-, 9 double- and 9 triple-vessel disease. The transesophageal dipyridamole test showed a specificity of 100% and an overall sensitivity of 92%. The sensitivity of this test for single-, double- and triple-vessel disease was 67%, 100% and 100%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)