Lefkos N, Boudonas G, Styliadis IG, Efthimiadis A, Paletas K,
Lefkou E, Tsapas G
Dobutamine stress echocardiography for detection of coronary
artery disease in hypertensive patients
12th Annual ASH Meeting
Am J Hypertens
(Apr) 10:91A 1997
The purpose of this study was to compare the diagnostic accuracy of the
treadmill exercise
test and dobutamine stress echocardiography in detecting coronary artery
disease in
hypertensive patients with and without LVH.
Thirty patients (M=17, F=13, mean age 57±8 years) with history of
hypertension and known coronary artery disease confirmed by coronary
angiography were studied. Patients with AMI, unstable angina, severe heart
failure, severe valvular disease, severe hypertension, LBBB,
electrocardiographic evidence of left ventricular hypertrophy and ST-T
changes in baseline ECG were excluded. Patients were divided in two groups
according to LV mass Index, echocardiographically assessed. Group A
comprised
18 patients (M=10, F=8) with normal LV mass Index (< 130gm/sqm in male
and
<110gm/sq m in female) and group B 12 patients (M = 7, F = 5) with mild
to
moderate increased LVImass (<200mg/sq m in male and < 165mg/sq m in
female).
All patients underwent treadmill exercise test (according to Bruce protocol)
and dobutamine stress echocardiography followed within 3 days, which was
characterized as positive when new abnormalities in wall thickening and
motion during systole appeared. The reasons for terminating dobutamine test
was chest pain, breath shortness, palpitation, dizziness, nausea, peak dose,
new wall motion abnormality and target heart rate.
The treadmill exercise test was positive in 9 of group B patients (75%)
while dobutamine stress echocardiography was positive in all (100%)
Patients without LVH (group A) had lower percentage of both positive
treadmill exercise test (66%) and dobutamine stress echocardiography
(88%). There were no serious side effects with both tests.
The authors concluded that dobutamine stress echocardiography is a safe and
powerful
predictor of CAD in patients with hypertension and is significantly superior
to treadmill
exercise test independently of LVH.
Comment: The authors should have better defined the reason for
coronary
catheterization and the degree of CAD in both groups. Also, although the
authors conclude that dobutamine stress echocardiography is significantly
superior to the treadmill exercise test, it is not clear whether in fact
they established a statistically significant difference.
(Gerard Appell, M.D., Associate Professor, Bowman Gray School of
Medicine)
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12th Annual ASH Meeting
H: Pathophysiology :
Heart in hypertension
H: Pathophysiology :
Vascular pathology