Diagnosis of coronary artery disease in elderly patients: safety and efficacy of dobutamine echocardiography

Coronary artery disease may be difficult to diagnose in theelderly because its clinical symptomatology is frequently atypicaland because the performance of submaximal tests makes exercisestress testing sometimes unreliable. Dobutamine stress testingmay be a useful alternative in such patients. This study comparedthe safety and accuracy of dobutamine stress echocardiographyin 73 ‘young’ (<60 years old) and 63 ‘old’( 60 years old) patients without previous myocardial infarctionundergoing diagnostic coronary angiography. The sensitivity in young patients (79%, (67–91, 95% CI))was similar to that in old patients (80% (69–91, 95% CI)).Similar levels of specificity (88% (75–101, 95% CI) vs75% (54–96, 95% CI)) were foundin the two groups. Bothgroups showed a trend to a higher sensitivity for multi-vesseldisease than for single-vessel disease. No major side effectoccurred during the entire study and peak dose (40 µg. kg^–1 . min^–1) was attained with similar frequencyin both groups (56% vs 49%). Minor side effects occurred equallyin ‘young’ and ‘old’ patients and neverpersisted more than a few minutes after ending the first infusionof dobutamine. Dobutamine echocardiography appears to be safe and accuratefor the detection of coronary artery disease regardless of age.