Mechanisms of regional wall motion abnormalities in contrast-enhanced Dobutamine Stress Echocardiography
| Autor: | Tanja Kaiser, Jörg Marienhagen, Andreas Luchner, Norbert Heinicke, Johann Schönberger, Mark Segmüller, Christoph Eilles, Stephan R. Holmer, Günter A.J. Riegger, Bernhard Benesch, Kurt Debl |
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| Rok vydání: | 2006 |
| Předmět: |
Male
Technetium Tc 99m Sestamibi Coronary angiography medicine.medical_specialty Cardiotonic Agents Dobutamine stress echocardiography media_common.quotation_subject Coronary Artery Disease Coronary Angiography Sensitivity and Specificity Coronary artery disease Predictive Value of Tests Dobutamine Internal medicine medicine Stress Echocardiography Humans Contrast (vision) Wall motion media_common Tomography Emission-Computed Single-Photon Chi-Square Distribution business.industry General Medicine Middle Aged medicine.disease Cardiology Female Radiology Radiopharmaceuticals Cardiology and Cardiovascular Medicine business Perfusion medicine.drug |
| Zdroj: | Clinical Research in Cardiology. 95:650-656 |
| ISSN: | 1861-0692 1861-0684 |
| DOI: | 10.1007/s00392-006-0443-2 |
| Popis: | In the diagnosis of coronary artery disease (CAD) with Dobutamine Stress Echocardiography (DSE), regional wall motion abnormalities (RWMA) are assumed to indicate a perfusion deficit.For a more particular examination of RWMAs, we compared simultaneous echo-contrast (Optisone)-enhanced DSE (0-40 microg/kg Dobutamine, 16-segment- model) and MiBi-SPECT in a prospective double-blinded study design in 69 non-selected consecutive patients (44 male, 25 female, age 64+/-12 years). Additionally, all patients were examined by coronary-angiography. The prevalence of significant CAD (stenosis50% lumen diameter) was 52%. DSE had a sensitivity of 78% and a specificity of 66% for the detection of significant CAD with a positive and negative predictive value of 72 and 73%, respectively. Among 28 patients with significant CAD and positive DSE study (true positive), 78% displayed a corresponding perfusion deficit in MiBi-SPECT. Among 11 patients with a positive DSE study but no current significant coronary stenosis (false positive), 82% showed stress-induced RWMAs in the inferior/posterior region, 73% displayed left ventricular hypertrophy, 54% resting-ECG abnormalities and 45% resting-RWMA (3 previous MI, 2 previous CABG surgery). Among 8 patients with negative DSE study but significant coronary stenosis (false negative), 75% had a stenosis of the LCX, 63% displayed resting- WMA, 63% displayed left bundle branch block or ST-segment depression, 50% displayed only peripheral coronary stenosis, and DSE visualization was suboptimal in 38%.This prospective study in non-selected patients shows that the majority of RWMAs in DSE are matched to a perfusion deficit detectable by nuclear imaging. Nevertheless, pre-existing cardiac abnormalities may also lead to stress-induced RWMA not associated with a perfusion deficit or mask a perfusion deficit upon DSE. Particularly in patients with LV hypertrophy, resting-RWMA, bundle branch block or ST segment depression, the predictive value of DSE may, therefore, be limited. |
| Databáze: | OpenAIRE |
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