Introduction: Echocardiography with dobutamine has been proposed as a useful tool in the diagnosis and assessment of coronary artery disease.
Patients and methods: To determine the usefulness of echocardiography combined with dobutamine infusion (10 micrograms/kg/min, with increments of 10 micrograms/kg/min every 3 min up to 40 micrograms/kg/min) and atropine if submaximal heart rate is not achieved in detecting coronary artery disease, 45 patients with chest pain underwent this test, exercise stress test and coronary angiography.
Results: No significant differences were found between double product (peak heart rate x systolic pressure) after dobutamine infusion (18,774) and after exercise (16,950; p = NS). Significant coronary artery disease, defined as having 70% stenosis in, at least, one major vessel, was present in 30 patients. Although overall sensitivity of dobutamine echocardiography test (70%) was similar than that obtained by exercise stress test (66%), sensitivity of the subgroup of patients with single-vessel disease was significantly higher (66 vs 42%, respectively; p < 0.05). Specificity was slightly higher with dobutamine echocardiography test (94%) than with exercise stress test (66%; p = 0.07). Side effects and major complications (hypotension, ventricular tachycardia, heart failure) were present in 8 (18%) and 3 (6%) patients, respectively. ECG during dobutamine administration become positive for ischemia in 17 patients with and 1 without coronary artery disease.
Conclusions: Dobutamine echocardiography test is highly sensitive and specific for the detection of coronary artery disease. Its sensitivity in patients with single-vessel disease is better than that obtained by exercise stress test. Complications after dobutamine infusion must be kept in mind.