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Head-to-Head Comparison of Dobutamine and Adenosine Stress Real-time Myocardial Perfusion Echocardiography for the Detection of Coronary Artery Disease

2007; Elsevier BV; Volume: 20; Issue: 9 Linguagem: Inglês

10.1016/j.echo.2007.02.008

1097-6795

Ingrid Kowatsch, Jeane Mike Tsutsui, Altamiro Filho Ferraz Osório, Augusto Hiroshi Uchida, Gilberto G.A. Machiori, Marden L. Lopes, Luı́z Antonio Machado César, José Antônio Franchini Ramires, Wilson Mathias,

Ultrasound and Hyperthermia Applications

We sought to determine the value of dobutamine versus adenosine real-time myocardial perfusion (MP) echocardiography for detecting coronary artery disease and the value of quantitative analysis of MP over electrocardiography, wall motion, and qualitative MP. We studied 54 patients by real-time MP echocardiography and coronary angiography. Replenishment velocity (β) and an index of myocardial blood flow (An×β) were derived from quantitative MP. During dobutamine stress, β (1.7 ± 0.7 vs 2.7 ± 1.2; P < .001) and An×β (2.2 ± 1.0 vs 3.5 ± 1.6; P < .001) reserves were lower in patients with coronary artery disease. The same was observed with adenosine for β (1.7 ± 0.8 vs 2.5 ± 1.1; P < .001) and An×β (1.9 ± 0.7 vs 3.2 ± 1.4; P < .001) reserves. Accuracy of electrocardiography, wall motion, qualitative MP, and quantitative MP were 61%, 76%, 76%, and 80% for dobutamine and 70%, 70%, 76%, and 80% for adenosine, respectively. Quantitative MP had incremental diagnostic value over other variables during dobutamine (χ2 23.7-38.4; P < .001) and adenosine (χ2 26.7-59.4; P < .001). In conclusion, dobutamine and adenosine real-time MP echocardiography hold similar accuracy for detecting coronary artery disease. Quantitative MP provides incremental diagnostic information over other variables. We sought to determine the value of dobutamine versus adenosine real-time myocardial perfusion (MP) echocardiography for detecting coronary artery disease and the value of quantitative analysis of MP over electrocardiography, wall motion, and qualitative MP. We studied 54 patients by real-time MP echocardiography and coronary angiography. Replenishment velocity (β) and an index of myocardial blood flow (An×β) were derived from quantitative MP. During dobutamine stress, β (1.7 ± 0.7 vs 2.7 ± 1.2; P < .001) and An×β (2.2 ± 1.0 vs 3.5 ± 1.6; P < .001) reserves were lower in patients with coronary artery disease. The same was observed with adenosine for β (1.7 ± 0.8 vs 2.5 ± 1.1; P < .001) and An×β (1.9 ± 0.7 vs 3.2 ± 1.4; P < .001) reserves. Accuracy of electrocardiography, wall motion, qualitative MP, and quantitative MP were 61%, 76%, 76%, and 80% for dobutamine and 70%, 70%, 76%, and 80% for adenosine, respectively. Quantitative MP had incremental diagnostic value over other variables during dobutamine (χ2 23.7-38.4; P < .001) and adenosine (χ2 26.7-59.4; P < .001). In conclusion, dobutamine and adenosine real-time MP echocardiography hold similar accuracy for detecting coronary artery disease. Quantitative MP provides incremental diagnostic information over other variables.