Comparison of exercise, dobutamine-atropine and dipyridamole-atropine stress echocardiography in detecting coronary artery disease

Abstract

Background: Dipyridamole and dobutamine stress echocardiography testing are most widely utilized, but their sensitivity remained suboptimal in comparison to routine exercise stress echocardiography. The aim of our study is to compare, head-to-head, exercise, dobutamine and dipyridamole stress echocardiography tests, performed with state-of-the-art protocols in a large scale prospective group of patients.

Methods: Dipyridamole-atropine (Dipatro: 0.84 mg/kg over 10 min i.v. dipyridamole with addition of up to 1 mg of atropine), dobutamine-atropine (Dobatro: up to 40 mcg/kg/min i.v. dobutamine with addition of up to 1 mg of atropine) and exercise (Ex, Bruce) were performed in 166 pts. Of them, 117 pts without resting wall motion abnormalities were enrolled in study (91 male; mean age 54 +/- 10 years; previous non-transmural myocardial infarction in 32 pts, angina pectoris in 69 pts and atypical chest pain in 16 pts). Tests were performed in random sequence, in 3 different days, within 5 day period under identical therapy. All patients underwent coronary angiography.

Results: Significant coronary artery disease (CAD; > or =50% diameter stenosis) was present in 69 pts (57 pts 1-vessel CAD, 12 multivessel CAD) and absent in 48 pts. Sensitivity (Sn) was 96%, 93% and 90%, whereas specificity (Sp) was 92%, 92% and 87% for Dobatro, Dipatro and Ex, respectively (p = ns). Concomitant beta blocker therapy did not influence peak rate-pressure product and Sn of Dobatro and Dipatro (p = ns).

Conclusion: When state-of-the-art protocols are used, dipyridamole and dobutamine stress echocardiography have comparable and high diagnostic accuracy, similar to maximal post-exercise treadmill stress echocardiography.

Figure 1

Sensitivity, specificity and diagnostic accuracy of stress echocardiography tests. Bar graph showing sensitivity (Sn), specificity (Sp) and diagnostic accuracy (Acc) of dobutamine-atropine (Dobatro), dipyridamole-atropine (Dipatro) and exercise (Ex) stress echocardiography tests. There was no statistically significant difference between three tests. Asterisk indicates significant difference between stress tests (p < 0.01).

Figure 2

Sensitivity of stress echocardiography tests in patients with and without concomitant beta-blocker therapy. Sensitivity of dobutamine-atropine (Dobatro), dipyridamole-atropine (Dipatro) and exercise (Ex) in patients with and without concomitant beta-blocker therapy. There was no significant difference in sensitivity for Dobatro and Dipatro between patients with (BB+) and without (BB-) concomitant beta-blocker therapy, whereas sensitivity of Ex was significantly higher in patients without concomitant beta-blocker therapy. Asterisk indicates significant difference between stress tests (p < 0.01).