Transesophageal dobutamine stress echocardiography for evaluation of patients with coronary artery disease

Echocardiography Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892.

OBJECTIVES. The present study was undertaken to determine the safety, feasibility and diagnostic accuracy of transesophageal dobutamine stress echocardiography for the evaluation of patients with known or suspected coronary artery disease. BACKGROUND. Dobutamine stress echocardiography has proved to be a valuable method for detecting and prognosticating ischemic heart disease. In addition, it may provide accurate information about myocardial viability in patients with systolic dysfunction. However, in some patients the technique may be limited by poor myocardial imaging with the conventional transthoracic approach. METHODS. Seventy-six patients (62 men, 14 women; mean age +/- SD 60 +/- 10 years) who underwent coronary angiography were included in the study. Transesophageal stress echocardiograms were performed after withdrawal of antianginal medications for > or = 48 h. Dobutamine was infused at a starting dose of 2.5 micrograms/kg body weight per min and was increased by 5-micrograms/kg per min increments every 5 min to a maximum of 40 micrograms/kg per min. Two-dimensional views were acquired at each stage and digitized for subsequent analysis. The left ventricle was divided into 16 segments, and each segment was assigned to a major coronary artery with the use of a model of regional distribution of coronary perfusion. RESULTS. Sixty-two of the 76 patients had angiographic evidence of coronary artery disease. New or worsening regional wall motion abnormalities developed during dobutamine infusion in 55 of these 62 patients and in none of the 14 patients with normal coronary arteries (sensitivity 89%, specificity 100%, overall accuracy 91%). Regional wall motion abnormalities in the distribution of more than one major coronary artery were seen in 3 of the 25 patients with single-vessel coronary artery disease and in 30 of the 37 patients with multivessel disease (p < 0.0001). The test was successfully completed in 73 (96%) of the 76 patients; it was discontinued in the remaining 3 patients because of intolerance to the probe. No major complications occurred in any patient. Minor complications developed in seven patients but did not affect the diagnostic accuracy of the test. CONCLUSIONS. Transesophageal dobutamine stress echocardiography is a safe, feasible and accurate method for assessing coronary artery disease. Its use should be considered in patients who have a suboptimal ultrasound window, and it provides an excellent tool for clinical investigations based on ultrasound imaging of the myocardium.

This article has been cited by other articles:

				E. C. Madu Transesophageal Dobutamine Stress Echocardiography in the Evaluation of Myocardial Ischemia in Morbidly Obese Subjects Chest, March 1, 2000; 117(3): 657 - 661. [Abstract] [Full Text] [PDF]

				S.-C. Chuah, P. A. Pellikka, V. L. Roger, R. B. McCully, and J. B. Seward Role of Dobutamine Stress Echocardiography in Predicting Outcome in 860 Patients With Known or Suspected Coronary Artery Disease Circulation, April 21, 1998; 97(15): 1474 - 1480. [Abstract] [Full Text] [PDF]

				R. O. Bonow Identification of Viable Myocardium Circulation, December 1, 1996; 94(11): 2674 - 2680. [Full Text]

				J. A. Panza, R. V. Curiel, J. M. Laurienzo, A. A. Quyyumi, and V. Dilsizian Relation Between Ischemic Threshold Measured During Dobutamine Stress Echocardiography and Known Indices of Poor Prognosis in Patients With Coronary Artery Disease Circulation, October 15, 1995; 92(8): 2095 - 2101. [Abstract] [Full Text]

				J. A. Panza, V. Dilsizian, J. M. Laurienzo, R. V. Curiel, and P. T. Katsiyiannis Relation Between Thallium Uptake and Contractile Response to Dobutamine : Implications Regarding Myocardial Viability in Patients With Chronic Coronary Artery Disease and Left Ventricular Dysfunction Circulation, February 15, 1995; 91(4): 990 - 998. [Abstract] [Full Text]