Pneumatic lower extremity compression during dobutamine stress echocardiography

Area of Science:

• Cardiology
• Diagnostic Imaging
• Physiology

Background:

• Increased afterload from lower extremity pneumatic compression is expected to elevate left ventricular (LV) wall stress.
• Elevated LV wall stress, a key determinant of myocardial oxygen demand, may enhance dobutamine stress echocardiography (DSE) sensitivity.

Purpose of the Study:

• To evaluate the impact of lower extremity pneumatic compression on the diagnostic performance of DSE.
• To assess changes in LV end-systolic volume and wall stress during DSE with concurrent pneumatic compression.

Main Methods:

• Dobutamine stress echocardiography (DSE) was performed on 40 patients prior to coronary angiography (CAG).
• The DSE protocol was repeated with lower extremity pneumatic compression (100 mmHg) in these patients (DSEcomp).
• Sensitivity and specificity of DSE and DSEcomp were compared against CAG findings.

Main Results:

• LV end-systolic volume and end-systolic wall stress were significantly higher during DSEcomp.
• DSEcomp improved sensitivity from 75% to 94% (p=0.045) by converting 3 false-negative DSE results to positive.
• Specificity slightly decreased from 88% to 83% (p=NS).
• Positive responses occurred earlier in DSEcomp for 10 of 12 patients with true positive results.

Conclusions:

• Pneumatic compression of the lower extremities significantly increases DSE sensitivity.
• This compression technique also shortens the time required to achieve a positive DSE response.
• DSEcomp demonstrates potential for improved early detection of coronary artery disease.