Document Detail


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.
MedLine Citation:
PMID:  8915229     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
J A San Román; I Vilacosta; J A Castillo; M J Rollán; V Peral; L Sánchez-Harguindey; F Fernández-Avilés
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Chest     Volume:  110     ISSN:  0012-3692     ISO Abbreviation:  Chest     Publication Date:  1996 Nov 
Date Detail:
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    
Other Details:
Languages:  eng     Pagination:  1248-54     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiology, Hospital Universitario, Valladolid, Spain.
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / adverse effects,  therapeutic use
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*
Cohort Studies
Coronary Angiography
Coronary Disease / diagnosis*,  ultrasonography
Coronary Vessels / physiopathology,  ultrasonography
Dipyridamole / adverse effects,  diagnostic use*
Dobutamine / adverse effects,  diagnostic use*
Echocardiography*
Electrocardiography
Exercise Test*
Female
Heart Rate / drug effects
Humans
Male
Middle Aged
Sensitivity and Specificity
Vasodilator Agents / adverse effects,  diagnostic use*
Chemical
Reg. No./Substance:
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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