RESUMO
OBJECTIVES: Assess the sensitivity and specificity of electrocardiograms performed during dopamine perfusion to detect coronary artery stenosis. PATIENTS AND METHODS: One hundred three coronary artery disease patients with a coronarography were studied; 23 coronarographies were normal, 59 patients were taking a beta blocker. An exercise test was also performed in 54 cases. A dobutamine perfusion was given at increasing dosage up to 50 micrograms/kg/min, in combination with intravenous atropine if needed to obtain a heart rate close to the theoretical maximum. RESULTS: The ST segment could not be analyzed reliably in 12 patients. There was an ST depression in 32 cases, an ST elevation in 20 and an isoelectric ST in 39. The sensitivity of a positive test to detect stenosis was 67% and specificity was 83%. Test sensitivity increases with increasing number of stenotic lesions. There were no false positives in patients with an ST elevation. Results were not related to gender nor beta blocker treatment. The exercise tests were globally comparable but poorer in patients taking beta blockers. There were no notable adverse effects. CONCLUSION: Dobutamine perfusion electrocardiogram is a simple well-tolerated exploration method for the diagnosis of coronary artery disease applicable in all patients. Its diagnostic value is similar to that of the exercise test and better in patients taking beta blockers. Specificity is excellent and sensitivity is acceptable, particularly in patients with mulitvessel disease.
