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

Chest. 1996 Nov;110(5):1248-54. doi: 10.1378/chest.110.5.1248.


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.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adrenergic beta-Antagonists / adverse effects
  • Adrenergic beta-Antagonists / therapeutic use
  • Angina Pectoris / drug therapy*
  • Anti-Arrhythmia Agents* / adverse effects
  • Atropine* / adverse effects
  • Blood Pressure / drug effects
  • Calcium Channel Blockers / adverse effects
  • Calcium Channel Blockers / therapeutic use
  • Cardiotonic Agents* / adverse effects
  • Cohort Studies
  • Coronary Angiography
  • Coronary Disease / diagnosis*
  • Coronary Disease / diagnostic imaging
  • Coronary Vessels / diagnostic imaging
  • Coronary Vessels / physiopathology
  • Dipyridamole* / adverse effects
  • Dobutamine* / adverse effects
  • Echocardiography*
  • Electrocardiography
  • Exercise Test*
  • Female
  • Heart Rate / drug effects
  • Humans
  • Male
  • Middle Aged
  • Sensitivity and Specificity
  • Vasodilator Agents* / adverse effects


  • Adrenergic beta-Antagonists
  • Anti-Arrhythmia Agents
  • Calcium Channel Blockers
  • Cardiotonic Agents
  • Vasodilator Agents
  • Dobutamine
  • Dipyridamole
  • Atropine