[The role of dobutamine stress echocardiography in the clinical routine of a department of cardiology]

Abstract

Background: The aim of this study was to assess the role of dobutamine stress echocardiography (SE) for diagnosis and therapy of coronary artery disease (CAD) in the routine practice of a cardiological department in which bicycle stress-testing, scintigraphy and coronary angiography are available.

Methods: Between January 1997 and September 1998, 123 patients (79 men, 44 women, 60.1 +/- 9.9 years) underwent SE. SE-indication, SE-result and the consequence of the SE were registered. A telephone follow-up, asking for events and cardiac interventions, took place after at least one year.

Results: SE was performed in 57 patients with suspected CAD and in 66 patients with known CAD. The indications were inconclusive bicycle stress-testing or perfusion scintigrams (n = 77), search for hibernation (n = 22), discrepancy between presenting symptoms and results of previous investigations (n = 14) and preoperative risk stratification (n = 10). In the group with suspected CAD, the proportion of female patients was higher (p = 0.001), in the group with known CAD the proportion of male patients was higher (p = 0.002). SE showed an ischemic reaction in 35 patients, hibernation in 24 patients, no ischemic reaction in 56 patients and was inconclusive in 8 patients. The consequence of SE was recommendation for diagnostic coronary angiography (n = 27), revascularisation (n = 10), abstention from any invasive intervention (n = 77), noncardiac surgery (n = 9) and electrophysiological investigation (n = 1). During the investigated period, 955 bicycle stress-tests, 677 Thallium scintigrams and 987 coronary angiograms were carried out. During the follow-up (15 +/- 2.9 months) 4 patients died. In 6 patients cardiac interventions were carried out. No differences were observed regarding events and interventions depending on SE results and consequences.

Conclusions: At a cardiological department SE plays a role if findings are inconclusive and if hibernation or operative risk is looked for. A negative SE result most commonly leads to abstention from invasive intervention. If the SE result is positive, the recommendation for invasive intervention is also influenced by the clinical symptoms and the size of the ischemically reacting myocardium.