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Is dobutamine-induced sinus node deceleration a marker of significant stenosis of the right coronary artery?

M Takeuchi1, H Hanada, T Numata

  • 1Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.

Chest
|March 14, 1998
PubMed

Insights

Sinus node deceleration during dobutamine stress echocardiography is more common than during exercise but not always indicative of right coronary artery stenosis. Further research into vagal activation mechanisms is needed.

Area of Science:

  • Cardiology
  • Clinical Medicine

Background:

  • Sinus node deceleration during exercise is a specific marker for right coronary artery stenosis.
  • Previous studies on dobutamine-induced sinus node deceleration involved limited patient numbers.

Purpose of the Study:

  • To evaluate the accuracy of sinus node deceleration as a marker for right coronary artery disease in a larger patient cohort.
  • To compare dobutamine stress echocardiography with treadmill ECG for detecting sinus node deceleration.

Main Methods:

  • Dobutamine stress echocardiography was performed in 757 patients.
  • Submaximal treadmill ECG was conducted in 571 patients.
  • Coronary angiography was performed in 631 patients to identify significant right coronary artery stenosis.

Main Results:

  • Dobutamine induced sinus node deceleration in 7% of patients, significantly higher than treadmill ECG (0.5%).
  • The specificity of dobutamine-induced sinus node deceleration for right coronary artery stenosis was 92%, higher than echocardiography (84%).
  • However, the positive predictive value for dobutamine-induced sinus node deceleration was lower (28%) compared to echocardiography (64%).

Conclusions:

  • Sinus node deceleration during dobutamine stress echocardiography is a frequent finding but not consistently associated with significant right coronary artery stenosis.
  • The mechanism is likely related to vagal activation.
  • This finding suggests a need for caution when interpreting sinus node deceleration as a sole indicator of coronary artery disease.
Abstract

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