Document Detail

Influence of wall stress and left ventricular geometry on the accuracy of dobutamine stress echocardiography.
MedLine Citation:
PMID:  12383580     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: The goal of this study was to determine whether wall stress at rest and during stress could explain the influence of left ventricular (LV) morphology on the accuracy of dobutamine stress echocardiography (DSE). BACKGROUND: The sensitivity of DSE appears to be reduced in patients with concentric remodeling, but the cause of this finding is unclear. METHODS: We studied 161 patients without resting wall motion abnormalities who underwent DSE and coronary angiography. Patients were classified into four groups according to relative wall thickness (normal <0.45) and LV mass (normal </=131 g/m(2) in men and </=100 g/m(2) in women): normal geometry, concentric remodeling, concentric hypertrophy, and eccentric hypertrophy. Significant coronary artery disease was defined as >/=50% stenosis. Circumferential (cESS) and meridional end-systolic wall stress (mESS) were calculated at rest and peak DSE. RESULTS: Both false-negative and false-positive results for DSE were present in 35 patients (22%). The accuracy of DSE in patients with concentric remodeling (61%) was lower than that in patients with normal geometry (85%, p < 0.05) or concentric hypertrophy (86%, p < 0.05), but the accuracy with eccentric hypertrophy (64%, p < 0.05) was lower than with concentric hypertrophy. Patients in lowest quartile of cESS and mESS at peak had significantly lower sensitivity and accuracy than those in the highest quartile. A reduced cESS at peak (p = 0.012), presence of concentric remodeling (p = 0.044), and eccentric hypertrophy (p = 0.012) were significant predictors of both false-negative and false-positive results for DSE. CONCLUSIONS: The accuracy of DSE is influenced by the LV geometric pattern and peak wall stress.
Satoshi Yuda; Vincent Khoury; Thomas H Marwick
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Validation Studies    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  40     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2002 Oct 
Date Detail:
Created Date:  2002-10-17     Completed Date:  2002-11-04     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1311-9     Citation Subset:  AIM; IM    
University of Queensland, Brisbane, Australia.
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MeSH Terms
Coronary Angiography
Coronary Stenosis / classification,  complications,  physiopathology,  ultrasonography*
Dobutamine / diagnostic use*
Echocardiography, Stress / methods,  standards*
False Negative Reactions
False Positive Reactions
Hypertrophy, Left Ventricular / classification,  complications,  physiopathology,  ultrasonography*
Middle Aged
Sensitivity and Specificity
Severity of Illness Index
Ventricular Remodeling
Reg. No./Substance:

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