Diagnostic accuracy of dobutamine stress echocardiography for detection of coronary heart disease in hypertensive patients

To compare the diagnostic accuracy between dobutamme echocardiographyand treadmill exercise electrocardiography in detecting coronaryartery disease in hypertensive patients, 43 patients withoutelectrocardiographic evidence of left ventricular hypertrophyand basal ST-T changes, who had also undergone coronary angiography,were further evaluated by dobutamine echocardiography. The patientsalso underwent treadmill exercise echocardiography. Left ventricularmass index was calculated by echocardiography. Twenty-nine patientshad coronary artery disease, of whom 22 had multi-vessel diseaseand 14 a normal coronary anatomy. Twenty-eight patients hadan increased left ventricular mass index. The sensitivitiesof dobutaniine echocardiography and exercise electrocardiographyfor detecting coronary artery disease were 93% and 72% (P=0·08)respectively, and the specificities were 100% and 29%(P<0·005),respectively. Logistic regression analysis showed exercise electrocardiographyto be a poor predictor of coronary artery disease (P<0·09)but dobutamine echocardiography was significantly better (P<0·00l).When patients with increased left ventricular mass index wereexcluded, prediction of coronary anatomy by exercise electrocardiographyimproved only marginally (P=0·4) while dobutamine echocardiographywas significantly better (P<0·00l). Thus dobutamineechocardiography is superior to exercise electrocardiographyfor diagnosis of coronary artery disease in hypertensive patients.