[Diagnosis of myocardial ischemia by dynamic digital echocardiography with dobutamine and atropine]

Abstract

We studied 300 patients (p) with dobutamine stress echocardiography (DSE) and atropine. The indication were chest pain, abnormal electrocardiogram (ECG), abnormal stress electrocardiogram with or without chest pain or any combination of these. The DSE was evaluated with digitized imaging in long and short parasternal views and apical four and two chambers views before and during dobutamine test with simultaneous side by side display. In 21 p (56.7%) we found positive concordance in diagnosis of coronary artery disease (CAD) between coronary arteriography (CA) and DSE. In 13 of 37 p the concordance was negative by the two methods (35.1%); then the DSE was capable correctly predict in 34 p (91%). The abnormal CA and normal DSE were found in one p (4.5%) with 90% obstruction of a small diagonal vessel. In two women DSE was abnormal with inferior hypokinesis (13.3%) and the CA was normal. In 43 p (14.3%) ECG and DSE were positive for myocardial ischemia (MI); negative concordance of both procedures was found in 203 p (67.6%). ECG was abnormal and DSE normal in 46 p (15.3%) 61 p (20.3%) with DSE abnormal in 8 p (2.6%) 61 p (20.3%) had arrhythmias; in 55 (18.3%) premature ventricular contractions, one p with ventricular tachycardia (0.33%); 7.3% of them required endovenous lidocaine. Chest pain was present in 22 p (7.3%) and the treatment waqs sublingual isosorbide; hypotension appeared in 27 p (9%) and were treated with saline infusion. Hypertensive response was found in two p (0.66%) and were treated with nifedipine and smolol. We concluded that DSE with atropine has high sensibility (95.5%) and specificity (86.6%) in the diagnosis of ischemic heart disease. The adverse effects are nondangerous and easily resolved with medical treatment.