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Abnormal ventricular activation and repolarisation during dobutamine stress echocardiography in coronary artery
C A O'Sullivan1, M Y Henein, R Sutton
1Royal Brompton Hospital, London, UK.
Insights
Dobutamine stress causes distinct electrocardiogram (ECG) changes in coronary artery disease patients, with QRS duration and QTc interval lengthening correlating to wall motion abnormalities, unlike ST segment shifts.
Area of Science:
- Cardiology
- Non-invasive Cardiac Imaging
- Electrocardiography
Background:
- Coronary artery disease (CAD) diagnosis often relies on stress testing.
- Dobutamine stress echocardiography (DSE) is a key non-invasive tool.
- Understanding ECG changes during DSE can improve diagnostic accuracy.
Purpose of the Study:
- To evaluate electrocardiogram (ECG) alterations during dobutamine stress.
- To correlate these ECG changes with left ventricular (LV) wall motion disturbances in CAD patients.
- To assess the diagnostic value of specific ECG parameters during DSE.
Main Methods:
- Prospective study involving 27 CAD patients and 17 controls undergoing DSE.
- 12-lead ECGs recorded at rest and during dobutamine stress stages.
- Correlation analysis between ECG parameters (QRS duration, QTc interval, ST segment) and LV wall motion abnormalities.
Main Results:
- In CAD patients, QRS duration broadened and QTc interval prolonged during dobutamine stress, unlike controls.
- QRS duration changes correlated with systolic wall motion abnormalities (p < 0.02).
- QTc interval prolongation correlated with diastolic wall motion abnormalities (p < 0.02).
- ST segment shifts occurred in 16 patients but showed no consistent correlation with wall motion abnormalities.
Conclusions:
- Dobutamine stress induces characteristic ECG changes in CAD, including QRS widening and QTc prolongation.
- These specific ECG changes correlate with both systolic and diastolic LV dysfunction.
- QTc interval and QRS duration are more sensitive indicators of DSE-induced wall motion abnormalities than ST segment shifts.
Objective:
To assess possible ECG changes caused by dobutamine stress and their relation to wall motion disturbances in patients with coronary artery disease.
Design:
Prospective recording and analysis of 12 lead ECG at rest and during each stage of dobutamine stress echocardiography, and correlation with wall motion changes.
Setting:
A tertiary referral centre for cardiac disease equipped with non-invasive facilities for pharmacological stress tests.
Subjects:
27 patients, mean (SD) age 60 (8) years, with documented evidence of coronary artery disease in whom dobutamine stress echo was clinically indicated, and 17 controls of similar age.
Results:
In controls, all ECG intervals shortened with increasing heart rate but in the patient group only PR and QT intervals shortened while QRS duration broadened and QTc interval prolonged progressively. In the 27 patients, 16 developed chest pain, 15 with reduced left ventricular long axis systolic excursion (p < 0.001), and all showed reduced peak lengthening rate; ST segment shift appeared in 16, 13 of whom developed chest pain, but did not correlate with reduction of either systolic long axis excursion or peak lengthening rate; QRS duration broadened in 20, 16 with reduction of long axis excursion (p < 0.02) which was more often seen at the septum (p < 0.005); QTc interval prolonged in 19, all of whom had associated reduction of peak long axis lengthening rate (p < 0.02).
Conclusions:
QRS duration and QTc interval both normally shorten with dobutamine stress, while in coronary artery disease they both lengthen: changes in QRS duration correlate with systolic and QTc interval with diastolic left ventricular wall motion disturbances. ST segment shift also occurred in most patients, but without consistent correlation with wall motion abnormalities. It was thus less discriminating than the other two abnormalities in this respect.