Document Detail

Transesophageal dobutamine-atropine stress echocardiography: diagnostic accuracy for coronary stenosis detection and localization.
MedLine Citation:
PMID:  8894791     Owner:  NLM     Status:  MEDLINE    
Transesophageal echocardiography with dobutamine-atropine stress (TE-DASE) is a recently described technique for evaluation of coronary artery disease (CAD). We undertook this study prospectively to determine the feasibility, reliability and safety of this procedure in patients with known CAD and to evaluate its diagnostic accuracy for coronary stenoses of varying severity. Thirty-seven patients who underwent coronary arteriography (CART) and TE-DASE within a 3-month interval without intervening ischemic events or revascularisation were included in the study CART and stress echograms were independently evaluated by different observers. Stenosis was measured with calipers and a > or = 50% lumen diameter stenosis was considered significant. A reduction or lack of endocardial motion and/or wall thickening on progressive incremental stress was considered an abnormal response. TE-DASE could be successfully completed in 33/37 (90%) patients. Using a modified 16-segment model of the left ventricle (LV), 15.2 +/- 0.8 segments/patient and 501/528 (95%) segments overall could be optimally evaluated. Inter-observer concordance for an abnormal response was 94%. Predictive accuracies for one-vessel disease (1-VD), two-vessel disease (2-VD) and three-vessel disease (3-VD) were 88, 58 and 23% respectively. Overall sensitivity for detection of a significant (> or = 50%) stenosis was 72% (32% for moderate (50-69%), 90% for severe (> or = 70%) stenosis) and specificity was 96%. Diagnostic accuracy for localisation of significant stenosis was 95% for the left anterior descending artery (LAD), 86% for the left circumflex artery (LCX) and 88% for the right coronary artery (RCA). There were no major complications. We conclude that TE-DASE is a safe, reliable and easily-performed procedure and provides excellent visualisation of myocardial segments. Diagnostic accuracy for detection of severe stenosis and its localisation is excellent.
M Shahi; S Radhakrishnan; N Sinha; S Shrivastava
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  International journal of cardiology     Volume:  56     ISSN:  0167-5273     ISO Abbreviation:  Int. J. Cardiol.     Publication Date:  1996 Oct 
Date Detail:
Created Date:  1997-02-04     Completed Date:  1997-02-04     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  IRELAND    
Other Details:
Languages:  eng     Pagination:  185-92     Citation Subset:  IM    
Department of Cardiovascular Sciences, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
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MeSH Terms
Atropine / diagnostic use*
Cardiotonic Agents / diagnostic use*
Coronary Angiography
Coronary Disease / pathology,  physiopathology,  ultrasonography*
Coronary Vessels / pathology,  ultrasonography
Dobutamine / diagnostic use*
Echocardiography, Transesophageal*
Endocardium / physiopathology,  ultrasonography
Feasibility Studies
Image Processing, Computer-Assisted
Middle Aged
Myocardial Contraction
Observer Variation
Parasympatholytics / diagnostic use*
Prospective Studies
Reproducibility of Results
Sensitivity and Specificity
Stress, Physiological / physiopathology
Ventricular Function, Left
Reg. No./Substance:
0/Cardiotonic Agents; 0/Parasympatholytics; 34368-04-2/Dobutamine; 51-55-8/Atropine

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