In a pilot study of 27 patients, those who presented with chest pain underwent 2 dobutamine stress echocardiographic studies, 1 with high mechanical index harmonic imaging to analyze wall motion without contrast and 1...In a pilot study of 27 patients, those who presented with chest pain underwent 2 dobutamine stress echocardiographic studies, 1 with high mechanical index harmonic imaging to analyze wall motion without contrast and 1 with real-time low mechanical index perfusion imaging with intravenous Optison to assess myocardial perfusion and wall motion. All patients then underwent quantitative coronary angiography. Two independent reviewers demonstrated an improvement in sensitivity when analyzing myocardial perfusion. In the 21 patients who had significant coronary stenoses, 14 had abnormal myocardial perfusion detected at peak stress and 7 had abnormal wall motion detected by standard dobutamine stress echocardiography. There was decreased specificity with perfusion imaging by 1 reviewer. The addition of real-time perfusion imaging after intravenous contrast during dobutamine stress echocardiography has the potential to improve detection of coronary artery disease.展开更多
Although dobutamine-atropine stress echocardiography (DASE) is an established method for evaluating patients who have coronary artery disease(CAD), it can in crease test duration and a patient’s exposure to large dos...Although dobutamine-atropine stress echocardiography (DASE) is an established method for evaluating patients who have coronary artery disease(CAD), it can in crease test duration and a patient’s exposure to large doses of dobutamine. New protocols, including the early injection of atropine during dobutamine stress e chocardiography (EA-DSE), have been proposed to decrease test duration. This st udy compared the safety, efficacy, and accuracy of EA-DSE with those of DASE. W e retrospectively evaluated 3,163 patients who underwent DASE and 1,664 patients who underwent EA-DSE over a period of 12 years. In EA-DSE, atropine at a dose ≤2mg was started with 20 μg/kg/min of dobutamine if heart rate was < 100 beat s/min. Diagnostic accuracy for detecting CAD(>50%stenosis) was assessed in pati ents who underwent quantitative angiography ≤3 months of stress testing. The do butamine dose used in EA-DSE was smaller than that used in DASE(31±6vs 36±6 μg/kg/min, p< 0.0001), although the atropine dose was larger(0.8±.0.5 vs 0.5± .0.25 mg, p< 0.0001). EA-DSE resulted in a significantly shorter duration of do butamine infusion(12.4±.2.0 vs 14.6±.2.5 minutes, p < 0.0001), more diagnostic studies(88%vs 81%, p< 0.0001), and a lower incidence of minor adverse effects than did DASE. The rate of major adverse effects was similar in the 2 protocols . Sensitivities, specificities, positive predictive values, negative predictive values, and accuracies for detecting CAD were 84%, 90%, 93%, 76%, and 86%fo r EA-DSE and 86%, 78%, 84%, 79%, and 82%for DASE, respectively(p=NS). Ther efore, EA-DSE is a safe and effective alternative to DASE and had a similar acc uracy for the detection of CAD.展开更多
文摘In a pilot study of 27 patients, those who presented with chest pain underwent 2 dobutamine stress echocardiographic studies, 1 with high mechanical index harmonic imaging to analyze wall motion without contrast and 1 with real-time low mechanical index perfusion imaging with intravenous Optison to assess myocardial perfusion and wall motion. All patients then underwent quantitative coronary angiography. Two independent reviewers demonstrated an improvement in sensitivity when analyzing myocardial perfusion. In the 21 patients who had significant coronary stenoses, 14 had abnormal myocardial perfusion detected at peak stress and 7 had abnormal wall motion detected by standard dobutamine stress echocardiography. There was decreased specificity with perfusion imaging by 1 reviewer. The addition of real-time perfusion imaging after intravenous contrast during dobutamine stress echocardiography has the potential to improve detection of coronary artery disease.
文摘Although dobutamine-atropine stress echocardiography (DASE) is an established method for evaluating patients who have coronary artery disease(CAD), it can in crease test duration and a patient’s exposure to large doses of dobutamine. New protocols, including the early injection of atropine during dobutamine stress e chocardiography (EA-DSE), have been proposed to decrease test duration. This st udy compared the safety, efficacy, and accuracy of EA-DSE with those of DASE. W e retrospectively evaluated 3,163 patients who underwent DASE and 1,664 patients who underwent EA-DSE over a period of 12 years. In EA-DSE, atropine at a dose ≤2mg was started with 20 μg/kg/min of dobutamine if heart rate was < 100 beat s/min. Diagnostic accuracy for detecting CAD(>50%stenosis) was assessed in pati ents who underwent quantitative angiography ≤3 months of stress testing. The do butamine dose used in EA-DSE was smaller than that used in DASE(31±6vs 36±6 μg/kg/min, p< 0.0001), although the atropine dose was larger(0.8±.0.5 vs 0.5± .0.25 mg, p< 0.0001). EA-DSE resulted in a significantly shorter duration of do butamine infusion(12.4±.2.0 vs 14.6±.2.5 minutes, p < 0.0001), more diagnostic studies(88%vs 81%, p< 0.0001), and a lower incidence of minor adverse effects than did DASE. The rate of major adverse effects was similar in the 2 protocols . Sensitivities, specificities, positive predictive values, negative predictive values, and accuracies for detecting CAD were 84%, 90%, 93%, 76%, and 86%fo r EA-DSE and 86%, 78%, 84%, 79%, and 82%for DASE, respectively(p=NS). Ther efore, EA-DSE is a safe and effective alternative to DASE and had a similar acc uracy for the detection of CAD.
