Predictive Accuracy of Dobutamine Stress Echocardiography in Detection of Presence and Extent of Coronary Artery Disease

M. Ahmed, A. Reza, K. Mohsin
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Abstract

Introduction: Exercise tolerance test (ETT) is an established screening test for coronary artery disease (CAD), but not feasible in 30−40% of patients. Dobutamine stress echocardiography (DSE) is an excellent alternative. Traditionally, inducible worsening of wall motion by 1 grade from baseline provides an index of CAD; worsening by 2 grade or more theoretically represents a more severe perfusion abnormality. The present study represents the inaugural experience of DSE at the National Institute of Cardiovascular Disease, Dhaka. Objective: To assess the predictive accuracy of DSE results with the presence and extent of CAD in subjects with suspected stable angina pectoris. Materials and Methods: In this prospective observational study, 35 subjects with intermediate to high probability of CAD were subjected to DSE followed by coronary angiography (CAG) within one month. Comparison of DSE results and predicted coronary artery involvement with angiographic findings were done. Overall sensitivity, specificity, accuracy as well as accuracy by arterial territory involvement were calculated. Results: DSE identified 82 abnormal segments, 66 with 1 grade change in 23 subjects (Group A) and 16 with 2 grade change in 8 subjects (Group B). CAG detected 54 significant lesions, 23 (42.59%) in left circumflex (LCX), 18 (33.33%) in left anterior descending (LAD), 11 (20.37%) in right coronary (RCA) and 2 (3.7%) in left coronary (LCA) artery. DSE had a sensitivity of 93.1% and a specificity of 66.7%. The accuracy was 88.57% overall, 94.29% for LAD and 91.43% for both LCX and RCA territories. Group B subjects had significantly higher number of coronary stenosis per patient (2.63 versus 1.38, p<0.001), triple vessel (62.5% versus 8.6%, p=0.003) and lower single vessel CAD (0% versus 47.8%, p=0.005). Conclusion: This study shows that DSE is a reliable test for prediction of the presence and extent of CAD. J Enam Med Col 2019; 9(1): 16-24
多巴酚丁胺应激超声心动图检测冠状动脉疾病的存在和程度的预测准确性
运动耐量试验(ETT)是一种公认的冠状动脉疾病(CAD)筛查试验,但在30 ~ 40%的患者中不可行。多巴酚丁胺应激超声心动图(DSE)是一个很好的选择。传统上,诱导壁运动从基线恶化1级提供CAD指标;恶化2级或以上理论上代表更严重的灌注异常。本研究代表了达卡国家心血管疾病研究所DSE的首次经验。目的:评价疑似稳定型心绞痛患者DSE结果对冠心病存在及程度的预测准确性。材料与方法:本前瞻性观察研究选取35例冠心病中高概率患者,在1个月内行DSE行冠状动脉造影。将DSE结果和预测冠状动脉受累与血管造影结果进行比较。计算总体敏感性、特异性、准确性以及动脉受累范围的准确性。结果:DSE检出82个异常节段,其中A组23例,66例为1级改变,B组8例,16例为2级改变。CAG检出明显病变54个,其中左旋(LCX) 23个(42.59%),左前降(LAD) 18个(33.33%),右冠状动脉(RCA) 11个(20.37%),左冠状动脉(LCA) 2个(3.7%)。DSE敏感性为93.1%,特异性为66.7%。总体准确率为88.57%,LAD为94.29%,LCX和RCA区域均为91.43%。B组患者的冠状动脉狭窄发生率(2.63比1.38,p<0.001)、三支血管(62.5%比8.6%,p=0.003)和单支血管冠心病发生率(0%比47.8%,p=0.005)均显著高于B组。结论:本研究表明DSE是预测CAD存在和程度的可靠测试。中南医学院2019;9 (1): 24
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35 weeks
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