Chest
Cardiolog: Clinical InvestigationsDipyridamole 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
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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.
REFERENCES (35)
- et al.
New developments in pharmacological stress imaging
Am Heart J
(1992) - et al.
Stress echocardiography: comparison of exercise, dipyridamole, and dobutamine in detecting and predicting the extent of coronary artery disease
J Am Coll Cardiol
(1995) - et al.
High dose dipyridamole echocardiography test in effort angina pectoris
J Am Coll Cardiol
(1986) - et al.
Dobutamine stress echocardiography for the detection and assessment of coronary artery disease
J Am Coll Cardiol
(1992) - et al.
Comparison of dobutamine stress echocardiography, dipyridamole stress echocardiography and exercise stress testing for diagnosis of coronary artery disease
Am J Cardiol
(1993) - et al.
Effect of prior myocardial infarction and extent and location of coronary disease on accuracy of exercise echocardiography
J Am Coll Cardiol
(1987) - et al.
Enhanced sensitivity for detection of coronary artery disease by addition of atropine to dobutamine stress echocardiography
Am J Cardiol
(1992) - et al.
Optimal use of dobutamine stress for the detection and evaluation of coronary artery disease: combination with echocardiography or scintigraphy, or both?
J Am Coll Cardiol
(1993) - et al.
Effect of beta-adrenoceptor blockade on dipyridamole induced myocardial asynergies in coronary artery disease
Am J Cardiol
(1992) - et al.
Dobutamine digital echocardiography for detecting coronary artery disease
Am J Cardiol
(1991)
Elektrokardiographische untersuchungen bei kranker mit angina pectoris (‘ambulatorischer typus')
Z Klin Med
Stress echocardiography: ready for routine clinical use?
Eur Heart J
Dobutamine versus dipyridamole echocardiography in coronary artery disease
Circulation
Comparison of adenosine, dipyridamole, and dobutamine in stress echocardiography
Ann Intern Med
Pharmacological stress echocardiography in the diagnosis of coronary artery disease and myocardial ischemia: a comparison between dobutamine and dipyridamole
Eur Heart J
Selection of the optimal nonexercise stress for the evaluation of ischemic regional myocardial dysfunction and malperfusion: comparison of dobutamine and adenosine using echocardiography and 99mTcMIBI single photon emission computed tomography
Circulation
Stress echocardiography in the detection of myocardial ischemia: head-to-head comparison of exercise, dobutamine and dipyridamole tests
Circulation
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revision accepted July 5.