Chest
Volume 110, Issue 5, November 1996, Pages 1248-1254
Journal home page for Chest

Cardiolog: Clinical Investigations
Dipyridamole and Dobutamine-Atropine Stress Echocardiography in the Diagnosis of Coronary Artery Disease: Comparison With Exercise Stress Test, Analysis of Agreement, and Impact of Antianginal Treatment

https://doi.org/10.1378/chest.110.5.1248Get rights and content

Study objectives

To compare the usefulness of dipyridamole echocardiography, dobutamine-atropine echocardiography, and exercise stress testing in the diagnosis of coronary artery disease and to analyze the agreement among the tests.

Design

Performance of these three tests in random order on a consecutive cohort of patients.

Setting

A tertiary care and university center.

Patients

One hundred two consecutive patients with chest pain and no history of coronary artery disease.

Interventions

Dipyridamole echocardiography, dobutamine-atropine echocardiography, exercise stress testing, and coronary angiography.

Measurements and results

Dobutamine-atropine test was positive in 49 (77%) of 63 patients with coronary artery disease, dipyridamole test in 49 (77%), and exercise stress test in 44 (68%; p=NS). Both echocardiographic tests showed an overall specificity (dipyridamole, 97%; dobutamine, 95%) higher than exercise stress test (79%; p<0.05). Sensitivity of dipyridamole testing decreased from 93 to 61% (p=0.002) if patients were receiving antianginal treatment but sensitivity of dobutamine-atropine testing was not affected (77% in patients receiving and not receiving treatment). When results were considered as positive-negative, agreement between dipyridamole and dobutamine-atropine echocardiography was 85% (kappa=0.70). With regards to regional analysis, concordance was good (93% for segments, kappa=0.76; and 95% for coronary arteries, kappa=0.92). Major complications were more frequent during dobutamine-atropine (n=7) than during dipyridamole infusion (n=2) (p=0.06).

Conclusions

Dobutamine-atropine and dipyridamole echocardiography have a similar sensitivity and a higher specificity than that obtained by exercise ECG for the diagnosis of coronary artery disease. Similar information is obtained with dipyridamole and dobutamine-atropine echocardiography. It is our thought that pharmacologic stress echocardiography should be used as a first-step test to rule out coronary artery disease in patients not capable of exercising.

Section snippets

Study Patients

The study group consisted of 102 consecutive patients, 57 men and 45 women with mean age of 62±11 years, who were admitted to the hospital for evaluation of chest pain and had no previous diagnosis of coronary artery disease. Patients with myocardial infarction and those with angiographically proved coronary artery disease were excluded. Other exclusion criteria were cardiac failure, angina uncontrolled with medical treatment, congenital or valvular disease, and cardiomyopathy. Clinical history

Stress Echocardiographic Findings

All patients had technically adequate two-dimensional echocardiograms in basal and stress conditions.

Stress echocardiographic, exercise stress test, and angiographic results of patients with either normal dipyridamole or dobutamine echocardiography (considered as “false-negative”) and significant coronary artery disease are depicted in Table 1.

Fifty patients had a positive dipyridamole test result. Dipyridamole time (time from the onset of dipyridamole infusion to development of asynergy) was

DISCUSSION

Several drugs have been utilized in combination with echocardiography to detect coronary artery disease. Studies designed to compare different types of pharmacologic and nonpharmacologic (exercise) stress would be useful to identify the safest and most effective test.

Three studies in which dipyridamole and dobutamine are compared obtain different results. Martin et al5 conclude that dobutamine is more sensitive, whereas comparable sensitivities and specificities have been reported by Previtali

ACKNOWLEDGMENTS

We gratefully acknowledge the technical assistance of Josefina Albújar, Olga Alfonso, Ana España, Inés Gómez, and María Sánchez.

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