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J Am Coll Cardiol, 2003; 41:1583-1589, doi:10.1016/S0735-1097(03)00242-0
© 2003 by the American College of Cardiology Foundation
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CLINICAL RESEARCH

Value of rapid beta-blocker injectionat peak dobutamine-atropine stressechocardiography for detection of coronary artery disease

Wilson Mathias, Jr, MD, PhD, FACC*,*, Jeane M. Tsutsui, MD, PhD*, José L. Andrade, MD, PhD*, Ingrid Kowatsch, MD*, Pedro A. Lemos, MD*, Samira M. B. Leal, MD, PhD*, Bijoy K. Khandheria, MD, FACC* and José F. Ramires, MD, PhD, FACC*

* Echocardiographic Laboratory, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil

Manuscript received August 20, 2002; revised manuscript received December 11, 2002, accepted January 9, 2003.

* Reprint requests and correspondence: Dr. Wilson Mathias, Jr., Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas Carvalho de Aguiar 44, São Paulo, Brazil, CEP:05403-000.
wmathias{at}incor.usp.br

OBJECTIVES: We studied the value of a rapid beta-blocker injection at peak dobutamine-atropine stress echocardiography (DASE) for the detection of coronary artery disease (CAD).

BACKGROUND: The presence of tachycardia and hyperdynamic wall motion may make it difficult to recognize a new wall motion abnormality (NWMA) at peak stress.

METHODS: We studied 101 patients (mean age 58.2 ± 9.8 years) who underwent effective DASE and coronary angiography. All patients received a rapid intravenous injection of metoprolol immediately after peak DASE image acquisition. Positivity in combined peak plus post-metoprolol images was defined when there was only peak NWMA, maintenance of peak NWMA, or NWMA detected only after metoprolol injection. Significant CAD was defined as ≥50% stenosis by quantitative angiography.

RESULTS: There were 37 patients without and 64 with CAD. The sensitivity, specificity, accuracy, and positive and negative predictive values for the detection of CAD at peak stress were 84%, 92%, 87%, 95%, and 77%, respectively. Five patients with CAD had negative peak images that became positive only after metoprolol. Extension of peak NWMA during metoprolol was observed in 14 patients, and multivessel CAD was detected in 10 of them. The sensitivity, specificity, accuracy, and positive and negative predictive values for peak plus metoprolol images were 92%, 89%, 91%, 94%, and 87%, respectively.

CONCLUSIONS: The use of metoprolol injected at peak of dobutamine infusion improved the detection of CAD by DASE.

Abbreviations and Acronyms
  CAD = coronary artery disease
  CI = confidence interval
  DASE = dobutamine-atropine stress echocardiography
  HR = heart rate
  NWMA = new wall motion abnormality
  QCA = quantitative coronary angiography
  WMSI = wall motion score index




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