|Dipyridamole and dobutamine-atropine stress echocardiography in the diagnosis of coronary artery disease. Comparison with exercise stress test, analysis of agreement, and impact of antianginal treatment.|
|PMID: 8915229 Owner: NLM Status: MEDLINE|
|STUDY OBJECTIVES: To compare the usefulness of dipyridamole echocardiography, dobutamine-atropine echocardiography, and exercise stress testing in the diagnosis of coronary artery disease and to analyze the agreement among the tests. DESIGN: Performance of these three tests in random order on a consecutive cohort of patients. SETTING: A tertiary care and university center. PATIENTS: One hundred two consecutive patients with chest pain and no history of coronary artery disease. INTERVENTIONS: Dipyridamole echocardiography, dobutamine-atropine echocardiography, exercise stress testing, and coronary angiography. MEASUREMENTS AND RESULTS: Dobutamine-atropine test was positive in 49 (77%) of 63 patients with coronary artery disease, dipyridamole test in 49 (77%), and exercise stress test in 44 (68%; p = NS). Both echocardiographic tests showed an overall specificity (dipyridamole, 97%; dobutamine, 95%) higher than exercise stress test (79%; p < 0.05). Sensitivity of dipyridamole testing decreased from 93 to 61% (p = 0.002) if patients were receiving antianginal treatment but sensitivity of dobutamine-atropine testing was not affected (77% in patients receiving and not receiving treatment). When results were considered as positive-negative, agreement between dipyridamole and dobutamine-atropine echocardiography was 85% (kappa = 0.70). With regards to regional analysis, concordance was good (93% for segments, kappa = 0.76; and 95% for coronary arteries, kappa = 0.92). Major complications were more frequent during dobutamine-atropine (n = 7) than during dipyridamole infusion (n = 2) (p = 0.06). CONCLUSIONS: Dobutamine-atropine and dipyridamole echocardiography have a similar sensitivity and a higher specificity than that obtained by exercise ECG for the diagnosis of coronary artery disease. Similar information is obtained with dipyridamole and dobutamine-atropine echocardiography. It is our thought that pharmacologic stress echocardiography should be used as a first-step test to rule out coronary artery disease in patients not capable of exercising.|
|J A San Román; I Vilacosta; J A Castillo; M J Rollán; V Peral; L Sánchez-Harguindey; F Fernández-Avilés|
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|Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial|
|Title: Chest Volume: 110 ISSN: 0012-3692 ISO Abbreviation: Chest Publication Date: 1996 Nov|
|Created Date: 1996-12-19 Completed Date: 1996-12-19 Revised Date: 2006-11-15|
Medline Journal Info:
|Nlm Unique ID: 0231335 Medline TA: Chest Country: UNITED STATES|
|Languages: eng Pagination: 1248-54 Citation Subset: AIM; IM|
|Division of Cardiology, Hospital Universitario, Valladolid, Spain.|
|APA/MLA Format Download EndNote Download BibTex|
Angina Pectoris / drug therapy*
Anti-Arrhythmia Agents / adverse effects, diagnostic use*
Atropine / adverse effects, diagnostic use*
Blood Pressure / drug effects
Calcium Channel Blockers / adverse effects, therapeutic use
Cardiotonic Agents / adverse effects, diagnostic use*
Coronary Disease / diagnosis*, ultrasonography
Coronary Vessels / physiopathology, ultrasonography
Dipyridamole / adverse effects, diagnostic use*
Dobutamine / adverse effects, diagnostic use*
Heart Rate / drug effects
Sensitivity and Specificity
Vasodilator Agents / adverse effects, diagnostic use*
|0/Adrenergic beta-Antagonists; 0/Anti-Arrhythmia Agents; 0/Calcium Channel Blockers; 0/Cardiotonic Agents; 0/Vasodilator Agents; 34368-04-2/Dobutamine; 51-55-8/Atropine; 58-32-2/Dipyridamole|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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