Dobutamine and exercise echocardiography in the evaluation of known or suspected coronary artery disease: an observational study from single centre

ABSTRACT

Stress echocardiography has emerged as an important tool for non-invasive assessment of coronary artery disease [CAD]. Exercise and dobutamine stress echocardiography [DSE] are frequently used modalities with distinct clinical indications and procedural variations. We report our findings on these two tests comparing various aspects and outcomes. Four hundred seventy one consecutive patients underwent SE at Sheikh Zayed Hospital Rahim Yar Khan. Exercise Echo [Ex.E] was performed on treadmill using Bruce's protocol. DSE performed in standard method. SE was considered as positive with the appearance of new or worsening wall motion abnormality. Ex.E performed by 300 patients and DSE 171 with mean age of 48.09 and 54.92 respectively. Males were dominant in both groups. The risk factors were almost same in both groups. Ex.E was more performed for diagnosis of CAD than DSE [59% vs 25%]. Viability testing was exclusively done by DSE. Post revascularization status was assessed in 10% and pre-operative assessment for non cardiac surgery in only 2%. Incidence of side effects was 26% in DSE and none in Ex.E. The double product was greater in Ex.E. Positive tests were reported in 43% and 33% in DSE and Ex.E respectively. Stress induced LV dysfunction was more common in DSE. Comparing available coronary angiograms, single vessel disease was better detected by DSE [60% vs 46%]. Double vessel disease was relatively higher in Ex.E [35% vs 28%]. Ex.E is safer and better non invasive diagnostic imaging modality in patients who can perform physical exercise, however DSE is more useful for viability, pre-operative evaluation and patients physically disabled for treadmill or ergometer exercise test