Dobutamine stress echocardiography as a predictor of coronary lesion severity on coronary angiography

In order to evaluate the capacity of dobutamine stress echocardiography (stress echo) to predict the severity of atherosclerotic lesions observed on coronary angiography in patients with coronary artery disease, we performed a retrospective study at Instituto Nacional de Cardiologia and Universidade Federal Fluminense, Brazil. The health records of 40 patients who underwent both stress echo and coronary angiography within a period of less than 14 days were assessed. For the stress echo analysis, the heart was divided into 16 segments and the different types of response assessed: biphasic, ischemic, viable or unchanged. The main arteries - left anterior descending artery (LAD), left circumflex coronary artery (LCx) and right coronary artery (RCA) and their branches - were studied by coronary angiography to assess the degree of obstruction (in %), the type of lesion (A, B1, B2 or C), and the presence or absence of collateral circulation. The following results were obtained: patients showing an altered response on stress echo (ischemic) presented a higher degree of coronary obstruction as well as more complex lesions in the anterior descending artery on coronary angiography. A higher degree of obstruction was associated with more complex lesions (in LAD, LCx and RCA) and collateral circulation (in LAD and RCA). The presence of more complex lesions also correlated with collateral circulation in the LAD. Based on these results, we concluded that dobutamine stress echocardiography is a non-invasive test capable of predicting the severity of coronary lesions in patients with chronic ischemic cardiopathy.