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A Elhendy

Publications and source records attributed to A Elhendy.

At least 73 records · Page 4Linked to original sources
PubMed1999

Stroke volume changes during dobutamine-atropine stress echocardiography: the influence of heart rate and ischaemia.

BACKGROUND: A decrease in stroke volume during dobutamine-atropine stress echocardiography heralds ischaemia and possible hypotension. Hypotension results from worsening of LV-function (as a result of ischaemia) left ventricular outflow tract obstruction or hypovolemia, while an increase of stroke volume indicates the preservation of myocardial contractile reserve. OBJECTIVE: To assess stroke volume changes during dobutamine stress echocardiography in relation to heart rate and occurrence of ischaemia and to validate a new automated cardiac output measurement device. METHODS: In fifty patients, the stroke volume was assessed using the echocardiographic biplane discs method during a stress echocardiography. These data were reference values for the validation of a new automated cardiac output measurement using the first method as a reference. RESULTS: Stroke volume measured by the biplane discs method and automated cardiac output device decreased from rest to peak stress, respectively, from 54+/-16 to 34+/-9 (63%) ml and 63+/-17 to 38+/-15 (60%) ml (p < 0.001). Stroke volume decreased with increased heart rate and stress-induced ischaemia when assessed by the biplane discs method, but with the automated device it decreased only with increased heart rate. CONCLUSIONS: Both increased heart rate and myocardial ischaemia during dobutamine stress echocardiography cause a reduction of stroke volume. However, the automated device did not detect the effects of stress-induced ischaemia on stroke volume. It appears that the biplane discs method is more sensitive for evaluating the effect of ischaemia.

Adrenergic beta-Agonists↗
PubMed1999

Myocardial perfusion abnormalities in treated hypertensive patients without known coronary artery disease.

OBJECTIVE: Myocardial perfusion abnormalities may occur in hypertensive patients in absence of significant coronary artery disease. However, it is not well established whether hypertensive patients without known coronary artery disease have a higher prevalence or extent of myocardial perfusion abnormalities compared with normotensive patients with similar clinical features. DESIGN: This study compares the prevalence and extent of rest and stress-induced myocardial perfusion abnormalities in patients with and without hypertension. METHODS: Dobutamine (up to 40 microg/kg per min) stress technetium-99m myocardial perfusion SPECT imaging was performed for evaluation of myocardial ischaemia in 350 patients (mean age = 60+/-13 years, 146 men) without known coronary artery disease. One hundred and forty-eight patients were hypertensive. Rest SPECT images were acquired 24 h after the test Abnormal perfusion was defined as the presence of reversible or fixed perfusion defects. RESULTS: No significant difference was detected between patients with and without hypertension regarding gender, prevalence of symptoms, risk factors, pretest probability of coronary artery disease (52+/-28 versus 53+/-29%), peak rate pressure product (21040+/-4755 versus 20774+/-4865) or number of patients achieving the target heart rate during stress (85 versus 86%). Hypertensive patients were significantly older (62+/-11 versus 58+/-13 years, P = 0.005) and were receiving beta-blockers more frequently (34 versus 18%, P = 0.0001). The prevalence of myocardial perfusion abnormalities was similar in patients with and without hypertension (28 versus 31% in patients with low, 38 versus 33% in patients with intermediate and 60 versus 58% in patients with high pretest probability of coronary artery disease, respectively). No significant difference was detected between the two groups regarding stress perfusion defect score (1.45+/-2.5 versus 1.50+/-2.6) or rest score (0.72+/-1.8 versus 0.68+/-1.6). CONCLUSION: Treated hypertensive patients without known coronary artery disease have a similar prevalence and severity of myocardial perfusion abnormalities at rest and at dobutamine stress compared with normotensive patients with similar clinical characteristics.

Adrenergic beta-Antagonists↗
PubMed1999

The functional significance of chronotropic incompetence during dobutamine stress test.

OBJECTIVE: To investigate the functional significance of chronotropic incompetence during dobutamine stress echocardiography. PATIENTS AND METHODS: The functional significance of chronotropic incompetence was evaluated during dobutamine stress echocardiography in 512 patients without beta blocker treatment who underwent dobutamine stress echocardiography (up to 40 microg/kg/min) and completed the protocol or reached the target heart rate. Mean (SD) age was 60 (12) years (313 men, 199 women). Chronotropic incompetence was defined as failure to achieve 85% of the maximum exercise heart rate predicted for age and sex (220 - age in men; 200 - age in women) at maximum dobutamine dose. RESULTS: Chronotropic incompetence occurred in 196 patients (38%). Affected patients were significantly younger, more likely to be men (both p << 0.001) and smokers (p < 0.05), had a higher prevalence of previous myocardial infarction (p < 0.005) and resting wall motion abnormalities (p < 0. 05), and had a lower resting heart rate (p << 0.001) and systolic blood pressure (p << 0.001) than patients without chronotropic incompetence, but there was no difference in the overall prevalence of ischaemia and significant coronary artery disease. By multivariate analysis, independent predictors of chronotropic incompetence were a lower resting heart rate (p << 0.001), younger age (p << 0.001), and male sex (p << 0.001). CONCLUSIONS: The relations among sex, age, and chronotropic incompetence show the need to titrate the dobutamine dose using specific data based on age and sex related heart rate responses to dobutamine rather than to an exercise stress test. Obtaining specific heart rate criteria is necessary to determine whether chronotropic incompetence represents a real failure to achieve a normal response or is the result of applying an inappropriate gold standard.

Aged↗
PubMed1999

Prediction of improvement of regional left ventricular function after revascularization using different perfusion-metabolism criteria.

UNLABELLED: Increased myocardial uptake of 18F-fluorodeoxyglucose (FDG) in regions with perfusion defects (perfusion-FDG mismatch) has been shown to predict functional recovery after revascularization; conversely, a concordant decrease in perfusion and FDG uptake (perfusion-FDG match) represents scar tissue (varying from subendocardial to transmural scar) that will not improve in contractile function after revascularization. Several recent studies have used a mild reduction in perfusion or FDG uptake (or both) as an indicator of viable tissue. To our knowledge, this criterion has not been validated against functional outcome after revascularization. This study aimed to compare the predictive value for functional recovery of these different perfusion-metabolism criteria. METHODS: Forty-two patients referred for revascularization were studied with early resting 201Tl SPECT (to evaluate perfusion) and FDG SPECT. Contractile function was evaluated before and 3-4 mo after revascularization using two-dimensional echocardiography. Angiography was not repeated. RESULTS: Two hundred six dysfunctional segments were identified; functional recovery occurred in 71 segments. The 206 dysfunctional segments were divided into five groups: group I, segments (n = 37) with normal perfusion; group II, segments (n = 69) with a mild reduction in perfusion (> or =60% of normal 201Tl uptake) without increased FDG uptake (mild match); group III, segments (n = 29) with a mild reduction in perfusion and increased FDG uptake (mild mismatch); group IV, segments (n = 46) with a more severe reduction in perfusion (<60% of normal 201Tl uptake) without increased FDG uptake (severe match); and group V, segments (n = 25) with a 201Tl activity < 60% and increased FDG uptake (severe mismatch). The mean wall motion score improved significantly in groups I, III and V but not in groups II and IV. Improvement of function was observed in 76% of group I segments, in 69% of group III segments and in 68% of group V segments. In contrast, only 13% of group II segments and 7% of group IV segments improved after revascularization. CONCLUSION: The results indicate that normal perfusion and mismatch patterns (either mild or severe) are predictive of functional recovery, whereas match patterns (either mild or severe) are predictive of absence of recovery. Match patterns are likely to represent different degrees of scar tissue, ranging from subendocardial to transmural scars. To identify segments with a high likelihood of improvement of function after revascularization, integration of information on perfusion and FDG uptake appears mandatory.

Angioplasty, Balloon, Coronary↗
PubMed1998

Optimal criteria for the diagnosis of coronary artery disease by dobutamine stress echocardiography.

The diagnosis of coronary artery disease (CAD) on the basis of inducible ischemia in > or = 2, rather than 1, segments was suggested to improve specificity of dobutamine stress echocardiography (DSE). However, the impact of using these criteria on the sensitivity and accuracy of DSE was not studied. We studied the accuracy of DSE (up to 40 microg/kg/min) for the diagnosis of CAD in 290 patients with suspected myocardial ischemia using the criteria of > or = 1 and > or = 2 ischemic segments. Ischemia was defined as new or worsening wall motion abnormalities using a 16-segment model. Among the 85 patients without previous myocardial infarction, significant CAD was detected in 51 (60%). Sensitivity, specificity, and accuracy of DSE using > or = 1 ischemic segment were 73%, 85%, and 78%, respectively. Those using > or = 2 segments were 67%, 94%, and 78%, respectively (p = NS). Regional specificity improved by using > or = 2 segments (91% vs 96%, p <0.05) at the expense of an equivalent reduction in regional sensitivity (60% vs 44%, p <0.05), whereas the regional accuracy was similar (80% vs 79% for > or = 1 and > or = 2 segments, respectively). In the 205 patients with previous myocardial infarction, the criterion of ischemia in > or = 1 segment had a higher sensitivity and accuracy for overall diagnosis of CAD (75% vs 64%, p <0.05; 77% vs 68%, p <0.05), infarct-related CAD (64% vs 47%, p <0.005; 70% vs 57%, p <0.01), and remote CAD (74% vs 57%, p <0.005; 78% vs 69%, p <0.05) than the criterion of > or = 2 segments, respectively. It is concluded that in patients without previous myocardial infarction, the use of > or = 2 ischemic segments by DSE for the diagnosis of CAD does not improve the accuracy of DSE compared with the criterion of > or = 1 ischemic segment. Conversely, in patients with previous infarction the use of > or = 2 segments reduces the overall and regional sensitivity and accuracy without a significant improvement in specificity.

Cardiotonic Agents↗
PubMed1998

Comparison of dobutamine stress echocardiography and technetium-99m sestamibi single-photon emission tomography for the diagnosis of coronary artery disease in hypertensive patients with and without left ventricular hypertrophy.

Stress echocardiography has been considered an accurate method for the diagnosis of coronary artery disease in hypertensive patients and in patients with left ventricular hypertrophy. In contrast, the specificity of myocardial perfusion scintigraphy in these patients has been questioned. The aim of this study was to compare the accuracy of these two imaging modalities in conjunction with dobutamine stress test for the diagnosis of coronary artery disease in hypertensive patients with and without left ventricular hypertrophy. Dobutamine (up to 40 microg kg-1min-1) stress echocardiography in conjunction with sestamibi (MIBI) single-photon emission tomography (SPET) was performed in 84 patients with the diagnosis of systemic hypertension who had been referred for evaluation of myocardial ischaemia. Ischaemia was defined as new or worsened wall motion abnormalities at echocardiography and reversible perfusion defects at SPET. Significant coronary artery disease (>/=50% luminal diameter stenosis) was detected in 66 patients (79%). The sensitivity, specificity and accuracy of the ischaemic pattern at echocardiography for the diagnosis of coronary artery disease were 73% (CI 63%-82%), 83% (CI 75%-91%) and 75% (CI 66%-84%), those for MIBI were 67% (CI 57%-77%), 83% (CI 75%-91%) and 70% (CI 60%-80%) respectively (P = NS vs echocardiography). Significant stenosis was detected in 123 (49%) of the 252 analysed coronary arteries. The sensitivity, specificity and accuracy of echocardiography for the regional diagnosis of coronary artery disease were 63% (CI 56%-69%), 90% (CI 86%-94%) and 77% (CI 72%-82%). Those for MIBI were 58% (CI 51%-64%), 91% (CI 87%-94%) and 75% (CI 69%-80) respectively (P = NS vs echocardiography). Left ventricular hypertrophy was detected in 59 patients (70%) by echocardiography and did not influence the overall or regional specificity of echocardiography or MIBI SPET. It is concluded that in hypertensive patients, dobutamine stress echocardiography and MIBI SPET have a comparable accuracy for the overall and regional diagnosis of coronary artery disease. Hypertensive patients with or without left ventricular hypertrophy should not be considered unsuitable candidates for stress myocardial perfusion scintigraphy.

Adrenergic beta-Agonists↗
PubMed1998

Quantification of the aortic valve area in three-dimensional echocardiographic data sets: analysis of orifice overestimation resulting from suboptimal cut-plane selection.

BACKGROUND: Our study was designed to determine the feasibility of three-dimensional echocardiographic (3DE) aortic valve area planimetry and to evaluate potential errors resulting from suboptimal imaging plane position. METHODS AND RESULTS: Transesophageal echocardiography with acquisition of images for 3DE was performed in 27 patients. Aortic valve orifice was planimetered in two-dimensional echocardiograms (2DE) and in two-dimensional views reconstructed from 3DE data sets optimized for the level of the cusp tips. To evaluate the errors caused by suboptimal cut-plane selection, orifice was also measured in cut-planes angulated by 10, 20, and 30 degrees or shifted by 1.5 to 7.5 mm. Planimetered orifice areas was similar in 2DE and 3DE studies: 2.09 +/- 0.97 cm2 versus 2.07 +/- 0.92 cm2. Significant overestimation was observed with cut-plane angulation (0.09, 0.19, and 0.34 cm2 at 10 degree increments) or parallel shift (0.11, 0.22, 0.33, 0.43, and 0.63 cm2 at 1.5 mm increments). Three-dimensional echocardiographic measurement reproducibility was very low and superior to that of 2DE. CONCLUSIONS: Three-dimensional echocardiography allows accurate aortic valve area quantification with excellent reproducibility. Relatively small inaccuracy in cut-plane adjustment is a major source of errors in aortic valve area planimetry.

Aortic Valve↗
PubMed1998

Biphasic response to dobutamine predicts improvement of global left ventricular function after surgical revascularization in patients with stable coronary artery disease: implications of time course of recovery on diagnostic accuracy.

OBJECTIVES: This study sought to evaluate the time course of improvement of left ventricular (LV) dysfunction in stable patients and its implications on the accuracy of dobutamine echocardiography for predicting improvement after surgical revascularization. BACKGROUND: Little is known about the optimal timing for evaluation of postrevascularization recovery of the contractile function of viable myocardium. METHODS: Sixty-one patients with chronic ischemic LV dysfunction scheduled for elective surgical revascularization were prospectively selected. They underwent dobutamine echocardiography (5 to 40 microg/kg body weight per min) and radionuclide ventriculography both preoperatively and at 3-month follow-up. At 14 months, another evaluation of LV function was obtained. To analyze echocardiograms, a 16-segment model and a five-point scoring system were used. Dyssynergic segments were considered likely to recover in the presence of a biphasic contractile response to dobutamine. Improvement of global function was defined as a > or =5% increase in LV ejection fraction (LVEF). RESULTS: Of the 61 patients, LVEF improved in 12 at 3 months and in 19 at late follow-up (from 32+/-8% to 42+/-9%, p < 0.0001). The frequency and time course of improvement of LVEF were similar in patients with mild and severe LV dysfunction. A biphasic response, identified in 186 of the 537 dyssynergic segments, was predictive of recovery in 63% at 3 months and in 75% at late follow-up. The positive predictive value was best in the most severe dyssynergic segments (90% vs. 67%). Other responses were highly predictive for nonrecovery (92%). The sensitivity and specificity for improvement of global function on a patient basis (> or =4 biphasic segments) were 89% and 81%, respectively, at late follow-up. CONCLUSIONS: Serial postoperative follow-up studies demonstrate incomplete recovery of contractile function at 3 months. The diagnostic accuracy of dobutamine echocardiography for predicting recovery is dependent on three factors: the combining of low and high dobutamine dosages, the severity of regional dyssynergy and the timing of evaluation.

Adult↗
PubMed1998

Impaired systolic blood pressure response to dobutamine stress testing: a marker of more severe functional abnormalities in patients with myocardial infarction.

Dobutamine-induced hypotension has been disregarded as a marker of more severe functional abnormalities in patients with suspected coronary artery disease. However, its functional significance in patients with myocardial infarction has not been studied. The aim of this study was to define the predictors of systolic blood pressure (SBP) response to dobutamine in patients with previous myocardial infarction. Dobutamine stress (up to 40 microg/kg per minute) echocardiography was performed in 326 patients with prior myocardial infarction referred for evaluation of myocardial ischemia. A 16-segment, four-grade score model was used to assess left ventricular function. Wall motion score index was derived by summation of wall motion score divided by 16. SBP and heart rate increased from rest to peak dobutamine stress (127 +/- 22 vs 134 +/- 27 mm Hg and 72 +/- 14 vs 122 +/- 24 bpm, p < 0.00001 in both). An increase of SBP > or = 30 mm Hg occurred in 50 patients (15%). By multivariate analysis, independent predictors of failure of SBP increase were higher peak wall motion score index (p < 0.001), higher resting SBP (p < 0.01), and medication with calcium channel blockers (p < 0.05). SBP drop > or = 20 mm Hg occurred in 54 patients (17%). Independent predictors of SBP drop were higher resting wall motion score index (p < 0.001), higher resting SBP (p < 0.0001), and older age (p < 0.05). In patients with myocardial infarction, left ventricular function and baseline systolic blood pressure are powerful predictors of SBP response to dobutamine stress testing.

Adrenergic beta-Agonists↗
PubMed1998

Prognostic implications of a normal dobutamine-atropine stress echocardiogram in patients with chest pain.

To assess the prognostic significance of a normal dobutamine-atropine stress echocardiogram in relation to the pretest probability of coronary artery disease (CAD), 200 consecutive patients (86 men and 114 women, mean [SD] age 59 [13] years) with a stable chest pain syndrome and a normal dobutamine-atropine stress echocardiogram were followed-up for 21 +/- 16 months. Outcome events were cardiac death, non-fatal myocardial infarction, and coronary revascularization procedures. Low (<10%), intermediate (10% to 80%), and high (>80%) pretest probabilities of CAD were present in 27 (14%), 108 (54%), and 65 (33%) patients, respectively. During follow-up, 2 patients (annual event rate 0.6%) had cardiac death, none had nonfatal myocardial infarction, and 4 patients (annual event rate 1.1%) underwent a coronary revascularization procedure. All patients with cardiac events had high pretest probabilities of CAD. Patients with cardiac death (but unproven significant CAD) had maximal tests without angina or ischemic electrocardiographic changes. In contrast, all patients with subsequent coronary revascularization had dobutamine-induced angina or ischemic electrocardiographic changes, and all except one study were submaximal. We conclude that patients with a stable chest pain syndrome and normal findings on dobutamine-atropine stress echocardiograms have an excellent cardiac prognosis. However, patients with typical angina, high pre-test probabilities of CAD, and stress-induced angina or ischemic electrocardiographic changes, and in particular those with submaximal stress, still appear to be at risk for functionally important CAD despite a normal dobutamine-atropine stress echocardiogram.

Adrenergic beta-Agonists↗
PubMed1998

Noninvasive diagnosis of coronary artery stenosis in women with limited exercise capacity: comparison of dobutamine stress echocardiography and 99mTc sestamibi single-photon emission CT.

OBJECTIVES: To compare the accuracy of dobutamine stress echocardiography (DSE) and simultaneous 99mTc sestamibi (MIBI) single-photon emission CT (SPECT) imaging for the diagnosis of coronary artery stenosis in women. PATIENTS: Seventy women with limited exercise capacity referred for evaluation of myocardial ischemia. METHODS: DSE (up to 40 microg/kg/min) was performed in conjunction with stress MIBI SPECT. Resting MIBI images were acquired 24 h after the stress test. Ischemia was defined as new or worsened wall motion abnormalities confirmed by DSE and as reversible perfusion defects confirmed by MIBI. Significant coronary artery disease was defined as > or = 50% luminal diameter stenosis. RESULTS: DSE was positive for ischemia in 35 of 45 patients with coronary artery stenosis and in 2 of 25 patients without coronary artery stenosis (sensitivity = 78% CI, 68 to 88; specificity = 92% CI, 85 to 99; and accuracy = 83% CI, 74 to 92). A positive MIBI study for ischemia occurred in 29 patients with coronary artery stenosis and in 7 patients without coronary artery stenosis (sensitivity = 64% CI, 53 to 76; specificity = 72% CI, 61 to 83; and accuracy = 67% CI, 56 to 78 [p < 0.05 vs DSE]). In the 59 vascular regions with coronary artery stenosis, the regional sensitivity of DSE was higher than MIBI (69% CI, 62 to 77 vs 51% CI, 42 to 59, p < 0.05), whereas specificity in the 81 vascular regions without significant stenosis was similar (89% CI, 84 to 94 vs 88% CI, 82 to 93, respectively). CONCLUSION: DSE is a useful noninvasive method for the diagnosis of coronary artery stenosis in women and provides a higher overall and regional diagnostic accuracy than dobutamine MIBI SPECT in this particular population.

Coronary Angiography↗
PubMed1998

Safety and feasibility of dobutamine-atropine stress echocardiography for the diagnosis of coronary artery disease in diabetic patients unable to perform an exercise stress test.

OBJECTIVE: Dobutamine stress testing is increasingly used for the diagnosis and functional evaluation of coronary artery disease. However, little is known about the safety and feasibility of this stress modality in diabetic patients. RESEARCH DESIGN AND METHODS: We studied the impact of diabetes on hemodynamic profile and on the safety and feasibility of dobutamine (up to 40 microg x kg(-1) x min(-1)) and atropine (up to 1 mg) stress echocardiography for the diagnosis of coronary artery disease in 1,446 consecutive patients (aged 60+/-12 years, 962 men) with limited exercise capacity and suspected myocardial ischemia. Of these, 184 patients were known to have IDDM or NIDDM. The test was considered feasible when 85% of the maximal heart rate and/or an ischemic end point (new or worsened wall motion abnormalities, ST segment depression, or angina) was achieved. RESULTS: No myocardial infarction or death occurred during the test. There was no significant difference between diabetic and nondiabetic patients with regard to heart rate increase during dobutamine stress echocardiography (58+/-25 vs. 61+/-24 beats/min), peak rate pressure product (18,400+/-3,135 vs. 18,048+/-4454), or the prevalence of hypotension (systolic blood pressure drop of >40 mmHg) (7 vs. 5%), ventricular tachycardia (5.4 vs. 4.5%), and supraventricular tachycardia (3 vs. 4%) during the test. Dobutamine stress echocardiography was feasible in 92% of the diabetic patients and in 90% of the nondiabetic patients. Coronary angiography was performed in 55 diabetic and 240 nondiabetic patients. Sensitivity, specificity, and accuracy of dobutamine stress echocardiography for the diagnosis of coronary artery disease in diabetic patients were 81, 85, and 82%. Those in nondiabetic patients were 74, 87, and 77%, respectively (NS). CONCLUSIONS: Dobutamine stress echocardiography is a feasible method for the diagnosis of coronary artery disease in patients with limited exercise capacity with a comparable safety, feasibility, and accuracy in diabetic and nondiabetic patients.

Aged↗
PubMed1998

Safety of dobutamine-atropine stress myocardial perfusion scintigraphy.

UNLABELLED: Dobutamine stress testing is increasingly used for the diagnosis and functional evaluation of coronary artery disease. However, the relationship between myocardial perfusion abnormalities and complications of the test has not been studied. METHODS: We studied the hemodynamic profile, safety and feasibility of dobutamine (up to 40 microg/kg/min)-atropine (up to 1 mg) stress myocardial perfusion SPECT imaging (with 201TI, 99mTc-MIBI or tetrofosmin) in a consecutive series of 1076 patients (age = 59 +/- 11 yr, 50% with previous myocardial infarction) referred for evaluation of myocardial ischemia. RESULTS: No infarction or death occurred during the test. The test was considered feasible (achievement of 85% of the target heart rate or an ischemic endpoint) in 1005 patients (94%). Hypotension (systolic blood pressure drop > or = 40 mm Hg) occurred in 37 patients (3.4%). Independent predictors were higher baseline systolic blood pressure (p < 0.0001), number of ischemic segments (p < 0.05) and age (p < 0.05). Supraventricular tachyarrhythmias occurred in 48 patients (4.4%). Independent predictors were fixed perfusion defect (infarction) score (p < 0.005) and age (p < 0.05). Ventricular tachycardia occurred in 41 patients (3.8%). Independent predictors were infarction score (p < 0.01) and male gender (p < 0.05). All arrhythmias terminated spontaneously or after metoprolol administration. CONCLUSION: Dobutamine-atropine myocardial perfusion scintigraphy is a feasible method for the evaluation of coronary artery disease with a safety profile and feasibility comparable to those reported for dobutamine stress echocardiography. Patients with more severe fixed perfusion abnormalities are at a higher risk of developing tachyarrhythmias during the test.

Atropine↗
PubMed1997

Gender differences in the accuracy of dobutamine stress echocardiography for the diagnosis of coronary artery disease.

The accuracy of dobutamine stress echocardiography (DSE) for the diagnosis of coronary artery disease (CAD) has not been yet evaluated in women. We studied the effect of gender on the accuracy of DSE for the diagnosis of CAD in 306 consecutive patients (210 men and 96 women) with limited exercise capacity and suspected myocardial ischemia who underwent coronary angiography within 3 months of DSE. There were no serious complications during DSE. Men had a higher prevalence of nonsustained ventricular tachycardia (7% vs 0.03%, p <0.05) and supraventricular tachycardia (9% vs 0.03%, p <0.05) during the test compared with women. Peak stress rate-pressure product was not different in men and women (18,140 +/- 4,187 vs 18,543 +/- 4,223). Significant CAD (> or =50% luminal diameter stenosis) was present in 171 men (81%) and in 62 women (65%, p <0.005). The sensitivity, specificity, and accuracy of ischemic pattern at DSE for the diagnosis of significant CAD were 76% (confidence interval [CI] 67 to 84), 94% (CI 89 to 99), and 82% (CI 75 to 90) in women and 73% (CI 67 to 79), 77% (CI 71 to 83), and 74% (CI 68 to 80) in men, respectively. Overall specificity was higher in women than in men (p <0.05). Regional accuracy of DSE was significantly higher in women than in men in the 3 arterial regions (84% [CI 79 to 88] vs 75% [CI 72 to 79], p <0.005). It is concluded that DSE is a safe and feasible method for the diagnosis of CAD in women. The overall specificity and the regional accuracy of DSE are higher in women than in men. Further studies are required to evaluate the functional significance of these findings and their reproducibility in different patient populations.

Cardiotonic Agents↗
PubMed1997

Cardiac imaging for risk stratification with dobutamine-atropine stress testing in patients with chest pain. Echocardiography, perfusion scintigraphy, or both?

BACKGROUND: Pharmacological stress echocardiography and myocardial perfusion scintigraphy are used frequently for risk stratification in patients with suspected myocardial ischemia. However, their relative prognostic strength has never been explored. METHODS AND RESULTS: Two hundred twenty consecutive patients with chest pain (mean age, 60 +/- 12 years; 124 men, 115 with previous myocardial infarction) were studied with dobutamine-atropine stress echocardiography (ECHO) and simultaneous 99mTc sestamibi single photon emission computed tomography imaging (MIBI). Ischemia was defined as deterioration in left ventricular wall motion and reversible perfusion defects, respectively. ECHO was positive for ischemia in 76 and MIBI in 91 patients (agreement, 77%; kappa = .51). During follow-up of 31 +/- 15 months, 24 patients had hard cardiac events (nonfatal myocardial infarction or cardiac death). By univariate analysis, age, history of congestive heart failure, and any abnormality or ischemia on ECHO or MIBI were associated with cardiac events. Multivariate analysis revealed that age, abnormal ECHO (odds ratio [OR], 18.9; 95% CI, 2.5 to 146.0) or MIBI (OR, 12.8; 95% CI, 1.7 to 98.3), and ischemia on ECHO (OR, 4.0; 95% CI, 1.6 to 9.9) or MIBI (OR, 3.0; 95% CI, 1.2 to 7.4) had independent predictive values. When ECHO was used as a first option, the addition of MIBI to all nonischemic ECHO studies decreased the OR from 4.0 (95% CI, 1.6 to 9.9) to 3.8 (95% CI, 1.4 to 10.2). Addition of MIBI confined to nonischemic ECHO studies in which target heart rate was not attained (nondiagnostic studies) increased the OR to a maximal 5.7 (95% CI, 2.2 to 15.0). In contrast, the addition of ECHO to nondiagnostic MIBI studies was not useful. CONCLUSIONS: Dobutamine-atropine ECHO and MIBI provide comparable prognostic information. The addition of MIBI to ECHO may be useful in patients with nondiagnostic ECHO studies.

Aged↗