Heinicke, N. and Benesch, B. and Kaiser, T. and Debl, K. and Segmueller, M. and Schoenberger, J. and Marienhagen, J. and Eilles, C. and Riegger, G. A. J. and Holmer, S. and Luchner, A. (2006) Mechanisms of regional wall motion abnormalities in contrast-enhanced Dobutamine Stress Echocardiography. CLINICAL RESEARCH IN CARDIOLOGY, 95 (12). pp. 650-656. ISSN 1861-0684,
Full text not available from this repository. (Request a copy)Abstract
Background 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. Methods and results For a more particular examination of RWMAs, we compared simultaneous echo-contrast (Optisone((R)))-enhanced DSE (0-40 mu g/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 (stenosis > 50% 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%. Conclusion 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.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | CORONARY-ARTERY-DISEASE; LEFT-VENTRICULAR HYPERTROPHY; MYOCARDIAL-PERFUSION; HYPERTENSIVE PATIENTS; SESTAMIBI SPECT; CHEST-PAIN; TOMOGRAPHY; DIAGNOSIS; STENOSIS; EXERCISE; dobutamine; stress-echocardiography; MiBi-SPECT; wall motion abnormalities; perfusion |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Innere Medizin II Medicine > Abteilung für Nuklearmedizin |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 15 Jan 2021 13:14 |
| Last Modified: | 15 Jan 2021 13:14 |
| URI: | https://pred.uni-regensburg.de/id/eprint/33678 |
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