Value of dobutamine stress echocardiography [DSE] in assessment of coronary artery disease in high risk obese female patients with normal EF and stable angina pectoris. comparative study to coronary angiography

ABSTRACT

Study carried to determine the value of DSE in assessment of the presence of CAD in obese female patients with stable angina pectoris and normal EF>55% +/- other risk factors [diabetes mellitus, hypertension, hyperlipidaemia, and/or smoking] versus patients performing coronary angiography. Sensitivity and specificity. Chest pain with suspected CAD may be screened with non-invasive test that has high sensitivity and specificity. We studied 200 female obese patients in the period between 1/1/2007 until 31/12/2008 with stable angina referred to the National Heart Institute with suspected coronary artery disease. Obesity was defined as body weight>110kg in these patients with body waist>44 and body mass index was not considered. Transthoracic echocardiography at rest revealed EF>55% with no segmental wall motion abnormality at rest in 102 +/- 22 patients, paradoxical septal wall motion in 13 +/- 15 patients, left ventricular dilatation in 10 +/- 12 patients, no history of myocardial infarction and variable risk factors [diabetes mellitus, hypertension, hyperlipidaemia, and/or smoking] are present. All patients were subjected to dobutamine stress echocardiography [DSE] 4 stages; 5 micro g/kg/min, 10 micro g/kg/ml 15 micro g/kg/min and high dose 40ug/kg/min +/- atropine injection 1mg IV in the last stage. Coronary angiography was done in 148 patients. The results are compared to the data obtained from DSE with evaluation of sensitivity and specificity in these classes of patients. Group A 153/200 patients completed the full dose of DSE with no wall motion abnormality or other factors that necessitate stopping the examination as chest pain, angina equivalent, hypotension or life threatening arrhythmia. Their tests were considered negative. 124/153 patients of them has done coronary angiography and revealed no coronary artery disease. 25/153 patients had one vessel disease or minimal 2or3 vessel that does not recommend any intervention. 4/153 patients had one vessel disease or significant 2or3 vessel that does recommend intervention or CABG. Group B 40/200 patients had equivocal results because positivity of the test can not be proved after full dose of DSE and recommended coronary angiography to further evaluate coronary arteries. 31/40 patients had one vessel disease or minimal 2or3 vessel that does not recommend any intervention. 9/40 patients had one vessel disease or significant 2 or 3 vessel that does recommend intervention or CABG. Group C 7/200 patients had positive dobutamine stress echocardiography and coronary angiography revealed significant coronary artery disease. Sensitivity was 84% and specificity 90% with P value 0.0001. Dobutamine stress echocardiography is a simple screening test in high risk obese female patients with suspected CAD compared to invasive coronary angiography with high sensitivity and specificity