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[The predictive signs of multivessel coronary disease in echocardiography with dobutamine]
M Cladellas1, J Bruguera, S Grau
1Servicio de Cardiología, Hospital Universitario del Mar, Universidad Autónoma de Barcelona.
Insights
Dobutamine echocardiography effectively detects multivessel coronary artery disease. Key predictors include low heart rate (<94 bpm), ECG ischemia, and baseline echocardiogram abnormalities with dobutamine-induced asynergies.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Non-invasive Cardiac Assessment
Background:
- Coronary artery disease (CAD) remains a leading cause of mortality worldwide.
- Accurate detection of multivessel coronary artery disease (MVD) is crucial for guiding treatment strategies.
- Dobutamine stress echocardiography (DSE) is a valuable non-invasive tool for assessing myocardial ischemia.
Purpose of the Study:
- To evaluate the diagnostic performance of dobutamine echocardiography in identifying multivessel coronary artery disease.
- To identify independent predictors of multivessel coronary artery disease, considering the influence of beta-blocker therapy.
Main Methods:
- A total of 91 patients with suspected or known coronary artery disease underwent dobutamine stress echocardiography followed by coronary angiography.
- Patients were assessed for chest pain, extent of coronary disease post-myocardial infarction, or other indications.
- Multivariate analysis was employed to determine independent predictors of multivessel disease.
Main Results:
- Dobutamine echocardiography demonstrated a sensitivity of 93% and specificity of 46% for detecting multivessel coronary artery disease.
- A peak heart rate below 94 beats/min during dobutamine or atropine administration was a significant discriminator for multivessel disease.
- Independent predictors of multivessel disease included heart rate < 94 bpm, ECG signs of ischemia, and resting echocardiogram abnormalities with remote asynergies during stress.
Conclusions:
- Dobutamine echocardiography is a sensitive method for detecting multivessel coronary artery disease.
- Specific factors like peak heart rate, ECG ischemia, and echocardiographic findings during stress are strong independent predictors of multivessel coronary artery disease.
Aims:
To assess the ability of dobutamine echocardiography to detect multivessel coronary artery disease and to determine predictive factors for multivessel disease with or without beta-blockers.
Patients And Methods:
A total of 101 patients underwent dobutamine stress echocardiography and coronary angiography (evaluation of chest pain 76, extent of coronary disease after myocardial infarction 19, other indications 6).
Results:
Ten patients in whom the test was prematurely terminated were excluded. Out of 91 patients who underwent dobutamine echocardiography, 54 patients had multivessel disease (sensitivity of dobutamine test 93%, specificity 46%). Heart rate at the maximum dose of dobutamine or atropine was 88 +/- 21 beats/min for multivessel diseases and 104 +/- 21 beats/min without multivessel disease (p < 0.001). A cut-off value < 94 beats/min discriminated patients at risk for multivessel disease. After adjusting for treatment with beta-blockers, heart rate < 94 beats/min, ECG signs of ischemia, and abnormalities on baseline echocardiogram with remote asynergies during dobutamine testing were independent predictors of multivessel disease in the multivariate analysis (probability > 90% when at least two factors were present).
Conclusion:
A heart rate < 94 beats/min at peak dose of dobutamine or after atropine, ECG signs of ischemia, and the presence of abnormalities on echocardiogram at rest with remote asynergies during dobutamine stress testing were independent predictive factors of multivessel coronary artery disease.