Dobutamine stress echocardiography: prevalence of a nonischemic response in a low-risk population

The problems of population referral bias in the calculation of specificity in diagnostic testing for coronary artery disease have been previously described. Previous studies investigating the sensitivity and specificity of dobutamine stress echocardiography (DSE) have been subject to pretest and posttest referral biases, largely as a result of the requirement for coronary arteriography. This study determines the normalcy rate for DSE by examining a population at statistically low risk for coronary artery disease. The probability of significant coronary artery disease was determined for 828 consecutive patients referred for DSE at the University of Michigan, and groups were identified with < 10% and < 5% probability of disease. Four of 72 patients (5.6%) with a normal baseline echocardiogram and a probability of coronary artery disease of < 10%, and three of 38 (7.9%) with a probability of < 5% were found to have an abnormal DSE, yielding normalcy rates of 94.4% and 92.1%, respectively. The area of abnormality involved the posterior circulation in three of four patients (75%). This study demonstrates that DSE has a normalcy rate of 92% to 94% and is an accurate test for excluding the presence of significant coronary artery disease.