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CLINICAL STUDY: MYOCARDIAL ISCHEMIA

Real-time three-dimensional dobutamine stress echocardiography in assessment of ischemia: comparison with two-dimensional dobutamine stress echocardiography

^a Division of Cardiology, University of Texas Medical Branch-Galveston, Galveston, Texas, USA

Manuscript received August 3, 2000; revised manuscript received December 8, 2000, accepted December 28, 2000.

Reprint requests and correspondence: Dr. Masood Ahmad, Division of Cardiology, University of Texas Medical Branch, 301 University Boulevard, 4.148 McCullough Building, Galveston, Texas 77555-0766
Mahmad{at}utmb.edu

OBJECTIVES

This study was designed to test the feasibility and efficacy of using real-time three-dimensional echocardiography (RT-3D) to detect ischemia during dobutamine-induced stress (DSE) and compares the results with conventional two-dimensional echocardiography (2D).

BACKGROUND

Real-time three-dimensional echocardiography, a novel imaging technique, offers rapid acquisition with multiple simultaneous views of the left ventricle (LV). These features make it attractive for application during stress.

METHODS

Of 279 consecutive patients screened for image quality by 2D, 253 patients with adequate images underwent RT-3D and 2D within 30 s of each other at baseline and at peak DSE.

RESULTS

Real-time three-dimensional echocardiography and 2D showed good concordance in detection of abnormal LV wall motion at baseline (84%: Kappa = 0.59) and at peak DSE (88.9%: Kappa = 0.72). Left ventricular wall motion scores were similar at baseline and peak DSE using both techniques. Interobserver agreements for detection of ischemia at peak DSE were superior for RT-3D, 92.7% compared with 84.6% for 2D (p < 0.05). Mean scanning time at peak stress by RT-3D in 50 randomly selected patients was shorter, 27.4 ± 10.7 s compared with 62.4 ± 20.1 s by 2D (p < 0.0001). In 90 patients with coronary angiograms, RT-3D had a sensitivity of 87.9% in the detection of coronary artery disease (CAD) compared with 79.3% by 2D.

CONCLUSIONS

Real-time three-dimensional dobutamine stress echocardiography is feasible and sensitive in the detection of CAD. The procedure offers shorter scanning time, superior interobserver agreements and unique new views of the LV.

Abbreviations and Acronyms   CAD = coronary artery disease   DSE = dobutamine stress echocardiography   LV = left ventricle   RT-3D = real-time three-dimensional echocardiography   2D = two-dimensional echocardiography

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