Related Experiment Videos
[Diagnosis of myocardial ischemia by dynamic digital echocardiography with dobutamine and atropine]
J F Guadalajara Boo1, O Galván Montiel, R Marrufo Hernández
1Instituto Nacional de Cardiologia Ignacio Chávez.
Insights
Dobutamine stress echocardiography (DSE) with atropine accurately diagnoses ischemic heart disease, showing high sensitivity and specificity. Adverse effects were minimal and easily managed, making DSE a reliable diagnostic tool.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Clinical Medicine
Background:
- Coronary artery disease (CAD) diagnosis relies on various methods.
- Stress echocardiography is a key non-invasive tool for assessing myocardial ischemia.
- Atropine can augment dobutamine stress echocardiography (DSE) for improved diagnostic accuracy.
Purpose of the Study:
- To evaluate the diagnostic performance of DSE with atropine in patients with suspected ischemic heart disease.
- To compare DSE findings with coronary arteriography (CA) and electrocardiogram (ECG) results.
- To assess the incidence and management of adverse effects during DSE.
Main Methods:
- 300 patients underwent DSE with atropine for indications including chest pain and ECG abnormalities.
- DSE utilized digitized imaging in multiple views before and during dobutamine infusion.
- Results were compared with coronary arteriography (CA) and electrocardiogram (ECG) findings.
Main Results:
- DSE showed positive concordance with CA in 56.7% of patients with confirmed CAD.
- DSE correctly predicted diagnosis in 91% of cases with discordant CA results.
- High sensitivity (95.5%) and specificity (86.6%) were observed for DSE in diagnosing ischemic heart disease.
- Adverse effects like arrhythmias and hypotension were infrequent and manageable.
Conclusions:
- DSE with atropine is a highly sensitive and specific method for diagnosing ischemic heart disease.
- The procedure is safe, with manageable adverse effects.
- DSE serves as a valuable tool in the diagnostic workup of patients with suspected coronary artery disease.
Abstract:
We studied 300 patients (p) with dobutamine stress echocardiography (DSE) and atropine. The indication were chest pain, abnormal electrocardiogram (ECG), abnormal stress electrocardiogram with or without chest pain or any combination of these. The DSE was evaluated with digitized imaging in long and short parasternal views and apical four and two chambers views before and during dobutamine test with simultaneous side by side display. In 21 p (56.7%) we found positive concordance in diagnosis of coronary artery disease (CAD) between coronary arteriography (CA) and DSE. In 13 of 37 p the concordance was negative by the two methods (35.1%); then the DSE was capable correctly predict in 34 p (91%). The abnormal CA and normal DSE were found in one p (4.5%) with 90% obstruction of a small diagonal vessel. In two women DSE was abnormal with inferior hypokinesis (13.3%) and the CA was normal. In 43 p (14.3%) ECG and DSE were positive for myocardial ischemia (MI); negative concordance of both procedures was found in 203 p (67.6%). ECG was abnormal and DSE normal in 46 p (15.3%) 61 p (20.3%) with DSE abnormal in 8 p (2.6%) 61 p (20.3%) had arrhythmias; in 55 (18.3%) premature ventricular contractions, one p with ventricular tachycardia (0.33%); 7.3% of them required endovenous lidocaine. Chest pain was present in 22 p (7.3%) and the treatment waqs sublingual isosorbide; hypotension appeared in 27 p (9%) and were treated with saline infusion. Hypertensive response was found in two p (0.66%) and were treated with nifedipine and smolol. We concluded that DSE with atropine has high sensibility (95.5%) and specificity (86.6%) in the diagnosis of ischemic heart disease. The adverse effects are nondangerous and easily resolved with medical treatment.