Dobutamine echocardiography and thallium-201 imaging predict functional improvement after revascularisation in severe ischaemic left ventricular dysfunction.

OBJECTIVES--To evaluate the concordance between thallium-201 uptake and echocardiographic wall thickening, which are both indicators of potentially reversible myocardial dysfunction, in patients with chronic ischaemic left ventricular failure and to assess their relative contribution to predicting improvement in regional function after revascularisation in a subgroup. PATIENTS AND METHODS--45 patients with chronic ischaemic left ventricular dysfunction (mean (SD) ejection fraction 25 (8)%) underwent echocardiography before and after dobutamine infusion (10 micrograms/kg/min). Of these, 22 patients underwent rest echocardiography at a mean (SD) of 9 (1) weeks after revascularisation. 201Tl imaging was performed during dobutamine echocardiography and at rest, 1, and 4 h after treatment with sublingual glyceryl trinitrate on two separate days. Potentially reversible dysfunction was thought to be present when a myocardial segment contained a Tl score of > or = 3 (ascending score 1-4), or showed improved wall thickening of a dysynergic segment during dobutamine stimulation. RESULTS--Of the 201Tl protocols, the redistribution scan 1 h after treatment with glyceryl trinitrate best demonstrated myocardial viability. Concordance between 201Tl and dobutamine induced wall thickening was 82% (kappa = 0.59) for detecting potentially reversible myocardial dysfunction before revascularisation (n = 45). Regional function improved in 18 of 22 patients after revascularisation. There were 168 dysynergic segments before intervention. The sensitivity of echocardiography and 201Tl imaging for detecting "recoverable" or viable segments after revascularisation was 87% and 92% respectively and specificity was 82% and 78% respectively (P = NS). CONCLUSIONS--Dobutamine echocardiography and 201Tl imaging may be used to predict mechanical improvement in dysynergic segments after revascularisation in patients with chronic ischaemic left ventricular dysfunction.     

Dobutamine stress echocardiography compared with dipyridamole thallium-201 single-photon emission computed tomography in detecting coronary artery disease

To compare the diagnostic value of dobutamine stress echocardiographywith dipyridamole thallium-201 single-photon emission computedtomography (SPECT) in detecting coronary artery disease (CAD),we performed both tests on 54 patients who also underwent coronaryarteriography. Dobutamine was infused at an incremental regimenof 5,10,20,30 and 40 µg. kg^-1. min^-1. Dipyridamole wasinfused at a rate of 0.14 mg. kg^-1. min^-1 over 4 min. Dobutaminestress echocardiography detected 40 (93%) and SPECT 42 (98%,P=ns) of the 43 patients with significant CAD, defined as (greaterthan or equal) 50% diameter stenosis. The specificity was 73%(8 of 11) for both tests. The sensitivity for detecting individualcoronary artery stenosis with dobutamine stress echocardiographywas 81% (30 of 37) for the left anterior descending artery,75% (24 of 32) for the right coronary artery, and 61% (17 of28) for the left circumflex artery. For SPECT it was 89%, 97%(P>0.05 vs dobutamine stress echocardiography) and 75%, respectively. Among the 97 stenotic coronary arteries, 17 had mild to moderatestenosis (50%-69% diameter stenosis) and 80 had severe stenosis($$70% diameter stenosis). With dobutamine stress echocardiography,53% of the arteries with mild to moderate stenosis were identifiedvs 78% of those with severe stenosis (P<0.05). With SPECT,the sensitivity was 82% (14 of 17) in mild to moderate stenosisand 89% (71 of 80) in severe stenosis (P=ns). No major sideeffects occurred during either test. Thus, both dobutamine stressand SPECT are highly sensitive for detection and localizationof CAD. However, the sensitivity of dobutamine stress is affectedby the level of stenosis severity.     

Concordance between dobutamine Doppler tissue imaging echocardiography and rest reinjection thallium-201 tomography in dysfunctional hypoperfused myocardium

OBJECTIVE—To evaluate the efficiency of the new technique colour Doppler tissue imaging (DTI) by studying the concordance between dobutamine DTI, standard grey scale echocardiography (SE), and rest-reinjection TI-201 tomography (TI) in dysfunctional myocardium.
PATIENTS—23 patients with chronic wall motion abnormalities and proven coronary artery disease (> 70% diameter stenosis of at least one major coronary artery at angiogram).
METHODS—The contractile reserve and the resting perfusion characteristics of dysfunctional myocardial segments were assessed with low dose dobutamine SE and/or DTI (2.5 up to 20 γ/kg/min) and TI on a semiquantitative basis. The DTI or SE data were separately compared with TI, on the basis of a 13 segment ventricular model. The resulting score of combined DTI and SE was also compared with TI. Finally the results obtained from DTI were compared with SE.
RESULTS—A total of 142 severely hypokinetic or akinetic segments were visualised. The viability study was feasible in 127 (89%) and 121 (85%) segments with DTI and SE, respectively. TI detected viability more frequently than DTI (84 v 61, p < 0.001) and SE (80 v 50, p < 0.001). However, as many viable segments were detected with combined DTI and SE as with TI (78 v 84, NS). The κ values between TI and SE, DTI or combined SE and DTI were 0.38, 0.45, and 0.57, respectively, and increased to 0.52 and 0.76, respectively, for SE and DTI versus TI when mid-anterior and mid-inferior segments only were considered. The κ value between SE and DTI was 0.34.
CONCLUSIONS—DTI is a helpful adjunct to SE, when using low dose dobutamine. This combination revealed as many viable segments as TI and showed a better agreement than DTI or SE alone for the assessment of myocardial viable segments evidenced by TI.


Keywords: colour Doppler tissue imaging; hibernating myocardium; thallium 201 single photon emission computed tomography; stress echocardiography     

Dobutamine magnetic resonance imaging as a predictor of myocardial functional recovery after revascularisation

OBJECTIVE—To assess the use of dobutamine magnetic resonance imaging (MRI) as a preoperative predictor of myocardial functional recovery after revascularisation, comparing wall motion and radial wall thickening analyses by observer and semi-automated edge detection.
PATIENTS—25 men with multivessel coronary disease and resting wall motion abnormalities were studied with preoperative rest and stress MRI.
MAIN OUTCOME MEASURES—Observer analysis for radial wall thickening was compared with a normal range, while wall motion analysis used a standard four point scale. Semi-automated analysis was performed using an edge detection algorithm. Segments displaying either improved or worsened thickening or motion with dobutamine were considered viable. Postoperative rest images were performed 3-6 months after coronary artery bypass grafting (CABG) for comparison.
RESULTS—For observer analysis the values for sensitivity and specificity were 50% and 72% for wall motion, with respective values of 50% and 68% for thickening. With semi-automated edge detection the figures for motion were 60% and 73%, with corresponding values of 79% and 58% for thickening. Combining thickening and motion for the semi-automated method to describe any change in segmental function yielded a sensitivity of 71% and specificity of 70%.
CONCLUSIONS—Dobutamine MRI is a reasonably good predictor of myocardial functional recovery after CABG. The use of semi-automated edge detection analysis improved results.


Keywords: dobutamine; magnetic resonance imaging myocardial viability; coronary artery bypass grafting     

Diagnosis of coronary artery disease in patients with permanent cardiac pacemaker by dobutamine stress echocardiography or exercise thallium-201 myocardial tomography

This study evaluated the use of dobutamine stress echocardiography and exercise thallium-201 myocardial computed tomography (CT) in the diagnosis of coronary artery disease (CAD) in patients with permanent transvenous pacemaker with the electrode implanted in the right ventricle (RV). Twenty-nine consecutive patients with pacemaker underwent dobutamine stress echocardiography, exercise thallium-201 myocardial CT, and coronary arteriography over a period of 8 +/- 1 days. None of these patients had suffered a myocardial infarction (MI). The cardiac rhythm of every patient was electrically paced during echocardiography and tomography. Sixteen (55%) patients showed CAD on angiography (stenosis > or = 50% of the luminal diameter of a major epicardial vessel). The detection sensitivity for CAD was 94% for the tomography and 88% for the echocardiography (P = NS). The difference between the sensitivities of the two techniques in detecting CAD based on the affected coronary artery was not statistically significant. Of the 13 patients without CAD, tomography showed a positive result in nine cases, i.e., a specificity of 31%, whereas echocardiography showed a positive result in only one case, i.e., a specificity of 92% (P < 0. 01). Exercise thallium-201 myocardial computed tomography produces an increased rate of false-positive results in patients with permanent transvenous cardiac pacemaker (PCP) implanted in the right ventricle (RV). Dobutamine stress echocardiography can thus be used to reduce considerably the level of false-positive results in these patients and still retain a detection sensitivity for CAD equal to that of myocardial tomography.     

Dobutamine stress echocardiography response of asymptomatic patients with diabetes

AIMS: This study investigated the role of dobutamine stress echocardiography for the silent diagnosis of myocardial ischemia in a diabetic population. Results from the stress test were compared between diabetic and nondiabetic groups. METHODS: Forty-nine diabetics and 63 consecutive nondiabetics underwent dobutamine stress echocardiography between April and December 1999, to check for new regional wall-motion abnormalities. A single operator, using the same echograph with tissue harmonic imaging in each case, performed all the examinations, using the same techniques. RESULTS: Significant coronary artery disease was detected in 9% of asymptomatic diabetics. Dynamic left ventricular obstruction was observed in 59% of the diabetic population and only 22% in the nondiabetic population. One patient suffered an adverse event (fast atrial fibrillation) during the stress test. Cardiac frequency at the beginning and end of the stress test differed significantly between the two populations. CONCLUSION: Dobutamine stress echocardiography allows for detection of silent myocardial ischemia. In the diabetic population, we describe, for the first time under dobutamine infusion, a great number of dynamic left ventricular obstructions.     

Assessment of myocardial perfusion with intravenous contrast echocardiography: comparison with (99) Tc-tetrofosmin single photon emission computed tomography and dobutamine echocardiography

The aim of the study was to evaluate the accuracy of intermittent, harmonic power Doppler (HPD) during intravenous Levovist infusion in identifying myocardial perfusion abnormalities in patients with recent infarction. Fifty-five patients with first acute myocardial infarction, successfully treated by primary PTCA, were studied after 1 month by myocardial contrast echocardiography (MCE), 99mTc tetrofosmin single photon emission computed tomography (SPECT), and low dose dobutamine echocardiography (DE). Scoring myocardial perfusion as normal, moderately, or severely reduced; MCE and SPECT were in agreement in 71% of segments(k = 0.414). Discordance was mainly due to ventricular walls with normal enhancement by MCE and moderate perfusion abnormalities by SPECT. Scoring perfusion as present or absent, the agreement significantly improved up to 86% (k = 0.59). Sensitivity and specificity of HPD for identifying SPECT perfusion defects were 63% and 93%, respectively. The agreement between MCE and SPECT was higher(85%, k = 0.627)in patients with anterior infarction. An improvement in regional contractile function was noted after dobutamine in 79 dysfunctional segments. A normal perfusion or a moderate perfusion defect by MCE were detected in 71 of 79 of these segments, while a severe perfusion defect was observed in 59 of 85 ventricular segments without dobutamine-induced wall-motion improvement. Sensitivity and specificity by HPD in detecting segments with contractile reserve were 90% and 69%, respectively. Thus, intermittent HPD during Levovist infusion allows myocardial perfusion abnormalities to be detected in patients with recent infarction. This method has a limited sensitivity but a high specificity in detecting SPECT perfusion defects, and a good sensitivity but a limited specificity in detecting contractile reserve.     

Comparison between dobutamine echocardiography and thallium-201 scintigraphy in detecting residual stenosis,ischemia, and necrosis in patients with prior myocardial infarction

Background: Following the first attempts to detect myocardial ischemia with two-dimensional echocardiography stress testing, pharmacologic stress using dobutamine infusion has become an alternative to echocardiography exercise testing for evaluation of coronary artery disease. It has been shown that stress echocardiography has a diagnostic accuracy similar to that of an exercise thallium test. Other studies, however, indicated that radionuclide myocardial perfusion imaging was more sensitive than exercise or pharmacologic stress echocardiography for detection of ischemia or jeopardized myocardium. Hypothesis: The aim of the present study was to determine the ability of dobutamine stress echocardiography in comparison with thallium-201 scintigraphy to identify multivessel disease and the presence of myocardial scar and ischemia in 60 consecutive patients who suffered a first myocardial infarction (MI). Methods: Patients were evaluated by coronary angiography and ventriculography, thallium-201 (²⁰¹Tl) tomographic scintigraphy, and dobutamine echocardiography within 3 months of a first MI. Forty-seven had Q-wave MI and 13 had non-Q-wave MI. Eleven patients were excluded from final analysis—7 because of failure to achieve target heart rate in spite of the use of atropine, and 4 because of high blood pressure following the infusion of dobutamine. Results: Dobutamine echocardiography showed an overall sensitivity of 43% for detection of coronary artery lesions of 50–74% diameter stenosis and ²⁰¹Tl scintigraphy showed a sensitivity of 71%. For detection of lesions of ≥75% diameter stenosis, dobutamine echocardiography showed a sensitivity of 52% and ²⁰¹Tl a sensitivity of 70%. Overall agreement between wall motion and myocardial perfusion for detection of necrosis and/or ischemia in the infarct area was 40.4% with a kappa coefficient of 0.09 (p = 0.13). For detection of ischemic myocardium outside the infarct zone, overall agreement was 78.6% with a kappa coefficient of 0.49 (p<0.0001). Conclusion: Dobutamine echocardiography results showed a lower sensitivity than myocardial perfusion images in predicting multivessel coronary artery disease, and there was poor agreement between both methods in identifying necrosis or ischemia.     

Identification of viable myocardium by perfusion imaging with intravenous contrast echocardiography after acute myocardial infarction

Myocardial perfusion contrast echocardiography is evolving into an effective method for the evaluation of myocardial blood flow after acute coronary events. The direct injection of ultrasound contrast agents into the aortic and coronary circulation has been shown to accurately identify areas of viable myocardial tissue. Recently, intravenous ultrasound contrast has been found to be useful in detecting microvascular blood flow after the restoration of blood flow in patients with myocardial infarction. We present the case of a patient in whom intravenous ultrasound contrast assisted in the detection of viable myocardial tissue after an acute ischemic syndrome.     

Dobutamine stress echocardiography: its role in the diagnosis of coronary artery disease.

We have assessed the usefulness of dobutamine infusion for the diagnosis of coronary artery disease by using two-dimensional echocardiography and 12-lead electrocardiogram. Dobutamine was infused at incremental doses (up to a maximum of 40 micrograms kg-1 min-1) in 52 patients with chest pain; all the patients underwent coronary angiography; significant coronary artery disease was quantitatively defined as greater than or equal to 50% diameter stenosis. Thirty-six patients were on betablockers. The test was considered positive when new regional wall motion abnormalities appeared during dobutamine infusion. No significant side effects occurred in any patient during the test. Transient wall motion abnormalities were detected in 20 of 37 patients with coronary artery disease (sensitivity = 54%); ischaemic ST segment changes were present on ECG in nine patients (sensitivity = 24%). Dobutamine stress echocardiography was negative in 12 of 15 patients with coronary artery diameter stenosis less than 50% (specificity = 80%). Exercise electrocardiography (ECG) was performed in 35 of these 52 patients. Maximum heart rate and systolic blood pressure were significantly higher during exercise than during dobutamine stress test (127 +/- 23 vs 99 +/- 24 beats min-1, P less than 0.0001; 179 +/- 25 vs 152 +/- 30 mmHg, P less than 0.0001). The exercise ECG test was positive in 12 of the 26 patients with significant coronary artery disease (sensitivity = 46%), and dobutamine stress echocardiography in 16 (sensitivity = 62%). Dobutamine stress echocardiography test is a safe and feasible diagnostic test for the noninvasive diagnosis of coronary artery disease and can be performed in patients unable to exercise.(ABSTRACT TRUNCATED AT 250 WORDS)     

Myocardial contrast echocardiography in the perfusion imaging in coronary occlusion and reperfusion

The availability of myocardial contrast echocardiography (MCE) has potential for several applications in coronary diseases. Experimental studies have demonstrated a good correlation between measurements of myocardial blood flow and regional contrast intensity, and therefore capabilities of MCE in detecting myocardial ischemia during stress. Clinical studies must then demonstrate the value of such approaches in comparison with existing techniques such as stress echo and radionuclide imaging.     

静息与负荷心肌造影超声心动图识别存活心肌的对比研究

目的探讨负荷心肌造影超声心动图(MCSE)对心肌梗死后存活心肌评价的疗效和安全性。方法选择冠状动脉造影证实的心肌梗死患者30例。首先在静息状态下行心肌造影超声心动图(MCE),MCE心肌灌注结果采用半定量评价。多巴酚丁胺负荷静脉滴注剂量分别为5、10、20μg·kg~(-1)·min~(-1),每期3 min观察心率、血压变化于达到负荷剂量后再次行MCE,并以~(18)F-脱氧葡萄糖正电子发射计算机体层扫描(PET)作为金标准评价其敏感性和特异性。结果 MCE总共评价360个梗死节段,静息MCE评价1、0.5、0分为264、22、74个节段。多巴酚丁胺负荷MCSE评价1、0.5、0分为286、30、44个节段,评价MCE敏感性和特异性分别为38.10%、88.89%,kappa=0.285(P0.01)。评价MCSE敏感性和特异性分别为86.21%、88.89%,kappa=0.746(P0.05)。结论MCE及MCSE安全性良好。MCE及MCSE均与冠状动脉造影心肌梗死部位有较好的相关性,以PET作为金标准,MCSE具有较高的敏感性和特异性,是评价梗死节段内存活心肌的较好方法。     

Real-time dobutamine stress myocardial perfusion echocardiography predicts outcome in the elderly.

AIMS: Although there is an increasing number of studies showing the value of perfusion imaging with real-time contrast echocardiography (RTCE) for detecting coronary artery disease (CAD), no data exist regarding the value of this technique for detecting CAD and predicting outcome in the elderly. METHODS AND RESULTS: We examined the outcome of 399 patients > or =70 years old who underwent dobutamine stress RTCE for known or suspected CAD. Myocardial perfusion imaging (MPI) was performed using low mechanical index pulse sequence schemes following intravenous small bolus injections of ultrasound contrast. Quantitative coronary angiography (QCA) was performed within 1 month of the stress test in 60 patients. Events were defined as cardiac death or non-fatal myocardial infarction (MI). Sensitivity of MPI for detecting CAD by QCA was 94% [confidence interval (CI) 91-99], specificity was 67% (CI 36-74), and accuracy was 90% (CI 82-95). During a median follow-up of 21 months, 46 events occurred (31 cardiac deaths, 15 non-fatal MI). Univariate predictors of outcome were diuretic use (P = 0.03), abnormal stress wall motion (P < 0.0001), and abnormal stress MPI (P < 0.0001). Abnormal stress MPI, however, was the most significant predictor of outcome (chi(2) 7.5; P = 0.006). CONCLUSION: Myocardial perfusion analysis during dobutamine stress RTCE provides incremental predictive value in determining the outcome of elderly patients being evaluated for the presence of CAD.     

小剂量多巴酚丁胺及其合用硝酸酯超声心动图试验识别冬眠心肌的对比研究

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Combined use of dobutamine echocardiography and myocardial contrast echocardiography in predicting regional dysfunction recovery after coronary revascularization in patients with recent myocardial infarction

BACKGROUND: Myocardial contrast echocardiography and dobutamine echocardiographyhave recently emerged as potentially useful clinical tools todetect reversible myocardial dysfunction. However, the relativeaccuracy of these two techniques in predicting regional wallmotion improvement after coronary interventions is still unclear.The aim of the present study was to compare their diagnosticvalue in predicting functional recovery after coronary revascularizationin patients with recent acute myocardial infarction. METHODS AND RESULTS: Twenty-four patients with acute myocardial infarction underwentmyocardial contrast echocardiography and dobutamine echocardiographywithin 2 weeks of hospital admission. Infarct zone contrastscore and wall motion score indexes were derived in each patient.Infarct-related artery revascularization was performed beforehospital discharge in all selected patients. Resting echocardiographywas repeated 3 months after revascularization, and regionalfunction recovery was analysed. The degree of wall motion scoreimprovement at 3-month follow-up and the percentage of positiveresponses to dobutamine echo were greater (P<0·001and P<0·002, respectively) in patients with a higherbaseline contrast score (0·50). Conversely, no significantchanges were observed either during dobutamine echo or afterrevascularization in the group of patients without residualperfusion within the infarct area. Diagnostic agreement betweenboth techniques in predicting reversible dysfunction was high(81% of segments). The sensitivity and negative predictive valuein predicting functional outcome were 100% (95% confidence interval[CI], 87% to 100%) and 100% (95% CI, 93% to 100%) by contrastecho, and 85% (95% CI, 66% to 96%) and 93% (95% CI, 84% to 98%)by dobutamine echo. The specificity and positive predictivevalue were 90% (95% CI, 80% to 96%) and 81% (95% CI, 64% to93%) by contrast echo, and 88% (95% CI, 78% to 95%) and 76%(95% CI, 58% to 90%) by dobutamine echo. The combination ofmyocardial contrast and dobutamine echocardiography positiveresponses improved specificity and positive predictive valuein detecting functional recovery after revascularization to100% (95% CI, 94% to 100%) and 100% (95% CI, 85% to 100%), respectively.However, the sensitivity and negative predictive value slightlydecreased with the use of both methods (85% [95% CI, 66% to96%)] and (93% [95% CI, 85% to 98%)], respectively. CONCLUSIONS: In patients with recent myocardial infarction, reversible dysfunctionafter coronary revascularization and the response to dobutamineinfusion are strictly dependent on microvascular integrity.However, microvascular perfusion does not always imply functionalrecovery after coronary revascularization. The integration withdob utamine echo results seems particularly helpful to furtherimprove myocardial contrast echo specificity and positive predictivevalues.     

Role of contrast-enhanced dobutamine stress echocardiography in predicting outcome in patients with known or suspected coronary artery disease

Although the application of intravenous contrast agents during stress echocardiography has been shown to improve diagnostic accuracy for detecting coronary artery disease, less information exists regarding its prognostic value. The aim of this study was to determine the role of contrast-enhanced dobutamine stress echocardiography (DSE) for predicting future cardiac events in patients with coronary artery disease (CAD). We studied 893 patients (mean age: 66, 581 men) with known or suspected CAD undergoing contrast-enhanced DSE. Positivity was defined as new/worsened wall motion abnormality or fixed abnormality during stress. All patients were followed for 15 +/- 10 months to evaluate hard cardiac events (cardiac death and nonfatal myocardial infarction) and total cardiac events (hard cardiac events, congestive heart failure, unstable angina, and late revascularization). Three patients were lost to follow-up, and 128 patients developed cardiac events, including 21 hard cardiac events. The 3-year event free survival rate was significantly lower in patients with positive DSE results than in those with negative DSE results. Stepwise Cox multivariate analysis revealed that positivity of DSE (P < 0.0001, Hazard ratio (HR): 2.48) and peak wall motion score index (WMSI) >1.5 (P < 0.0001, HR: 2.41) were independent predictors for total cardiac events. Considering hard cardiac events, the independent predictors were peak WMSI > 1.5 (P < 0.0001, HR: 6.65) and age > 70 years (P < 0.005, HR: 3.27). We conclude that contrast-enhanced DSE provides important prognostic information for future cardiac events.     

Detection of coronary artery disease with perfusion stress echocardiography using a novel ultrasound imaging agent: two Phase 3 international trials in comparison with radionuclide perfusion imaging

Aims: To determine if perfusion stress echocardiography (PSE) withImagify^TM (perflubutane polymer microspheres) is comparableto stress perfusion imaging using ^99mTc single photon emissioncomputed tomography (SPECT) for coronary artery disease (CAD)detection. PSE is a novel technique for evaluating myocardialperfusion. RAMP (real-time assessment of myocardial perfusion)-1and -2 were international, Phase 3 trials that evaluated theability of PSE with Imagify, to detect CAD. Methods and results: Chronic, stable, chest pain patients (n = 662) underwent ImagifyPSE and gated SPECT imaging at rest and during dipyridamolestress. Independent blinded cardiologists [three PSE readersper trial, and four SPECT readers (one for RAMP-1, three forRAMP-2)] interpreted images. CAD was defined by quantitativecoronary angiography or 90-day outcome with clinical review.Accuracy, sensitivity, and specificity were evaluated usingnon-inferiority analysis (one-sided alpha = 0.025) comparedwith SPECT. SPECT results for RAMP-1 and -2 were: accuracy (70%,67%), sensitivity (78%, 61%), and specificity (64%, 76%). Accuracyof all six PSE readers was non-inferior to SPECT (66–71%,P 0.004). Four demonstrated non-inferior sensitivity (68–77%,P 0.002), three demonstrated non-inferior specificity (72–88%,P 0.013). Three PSE readers (RAMP-2) were superior for sensitivity.Two PSE readers (RAMP-1) were superior for specificity. Areaunder the multi-reader receiver operating characteristics curve(0.72) was equal for both modalities. Majority of adverse eventsfollowed dipyridamole dosing, and were mild, transient, andrequired no treatment. Conclusions: Imagify PSE was well-tolerated. Its diagnostic performance inchest pain patients is comparable with SPECT perfusion imaging.     

Prognostic value of dobutamine echocardiography in elderly patients with suspected coronary artery disease and an abnormal resting electrocardiogram

The prognostic value of dobutamine stress echocardiography (DE) in elderly patients over 70 years of age with suspected coronary artery disease (CAD) and an abnormal electrocardiogram (ECG) at rest has not been well documented. We investigated 158 consecutive outpatients (97 men) aged 76 +/- 4 years presenting with right bundle branch block with or without a left anterior hemiblock (41%), left bundle branch block (23%), or repolarization abnormalities (36%). The basic clinical and echocardiographic data were analyzed and correlated with the DE results. The patients were followed for a mean of 24 +/- 13 months. Twenty-three (14.5%) patients presented with a nonfatal cardiac event (CE). According to univariate analysis, the parameters associated with the onset of a CE included arterial hypertension, angina pectoris, anti-angina therapy, the presence of calcifications on the aortic valve and the ascending walls of the aorta, and the presence of segmental-contraction abnormalities of the left ventricle (LV) at rest during echocardiography. According to a Cox regression model, the only independent predictive parameter for the onset of a CE was the appearance of segmental-contraction abnormalities of the LV and their severity during peak dose administration during DE (odds ratio [OR] = 2.58, P < 0.001). This parameter remains independent when spontaneous CEs (myocardial infarction and unstable angina) were considered as endpoints (OR = 2.31, P < 0.001). Conclusions: DE is a safe and reliable method for investigating CAD in patients over 70 years of age with an abnormal resting ECG. In our study, the most predictive independent parameter for the onset of a CE was the appearance of segmental-contraction abnormalities of the LV and their severity during DE.     

Dobutamine stress echocardiography in the diagnosis of coronary artery disease in women with chest pain: comparison with different noninvasive tests

BACKGROUND: Diagnosis of coronary artery disease(CAD) in women remains elusive. The classical diagnostic armamentarium has been found to be very limited. Dobutamine stress echocardiography has emerged as a powerful test in assessing CAD in the general population, but most studies failed to include women. HYPOTHESIS: The accuracy of dobutamine stress echocardiography in the diagnosis of CAD in women with chest pain is high and superior to dipyridamole echocardiography, exercise electrocardiography, and sestamibi single-photon emission tomography (MIBI-SPECT) scintigraphy. METHODS: We studied 99 consecutive women with chest pain and no previous history of CAD who underwent dobutamine echocardiography and coronary angiography. We also compared these results with those of dipyridamole echocardiography in 63 patients. exercise stress testing in 83 (48 conclusive), and MIBI-SPECT scintigraphy during dobutamine infusion in 54. RESULTS: Significant CAD was found in 42 women. Sensitivity and specificity of dobutamine stress echocardiography were 69 and 89%, respectively. Dipyridamole echocardiography showed similar accuracy (sensitivity 72% and specificity 94%). Finally, sensitivity of exercise test and MIBI-SPECT was similar (76 and 88%, respectively) and specificity was lower (53 and 57%, respectively). After excluding patients known to have a high incidence of false positive results, MIBI-SPECT specificity rose up to 80%. CONCLUSION: Dobutamine stress echocardiography and dipyridamole echocardiography bear a high diagnostic accuracy in women with chest pain. MIBI-SPECT is also a useful tool after excluding subgroups with a high incidence of false positive results.