Comparison of adenosine, dipyridamole, and dobutamine in stress echocardiography.

OBJECTIVE

To compare adenosine, dipyridamole, and dobutamine in stress echocardiography with regard to sensitivity, specificity, accuracy, and side effects.

DESIGN

Crossover, blinded comparison, with coronary angiography serving as the criterion standard.

SETTING

U.S. Army tertiary care hospital.

PARTICIPANTS

Forty participants, 25 with coronary disease and 15 without coronary disease. Patients were eligible if they had coronary angiography within 6 weeks of stress testing or if they had a risk for coronary disease of less than 5%.

MEASUREMENTS

Left ventricular wall motion was recorded after dobutamine (0.38 mg/kg body weight), adenosine (0.84 mg/kg body weight), and dipyridamole (0.84 mg/kg body weight) stress testing. Stress echocardiographic evaluation was considered to be abnormal if the patient developed new or progressive wall motion abnormalities. The rate of side effects for the types of echocardiography and the patient preference were recorded.

MAIN RESULTS

The sensitivity of dobutamine stress echocardiography (76%; 95% CI, 59% to 93%) was significantly higher than that of adenosine echocardiography (40%; CI, 21% to 59%; P less than 0.001) and that of dipyridamole echocardiography (56%; CI, 37% to 75%; P = 0.019). The specificity of adenosine testing (93%; CI, 80% to 100%) was significantly higher than that of dobutamine echocardiography (60%; CI, 35% to 85%; P = 0.008) and that of dipyridamole echocardiography (67%; CI, 43% to 91%; P = 0.028). Symptoms were more frequent with adenosine echocardiography (100%) than with dipyridamole (88%; P less than 0.001) or dobutamine (80%; P less than 0.001) echocardiography. Treatment for persistent symptoms was required in more patients after dipyridamole echocardiography (40%) than after dobutamine (12%; P less than 0.001) or adenosine (0%; P less than 0.001) echocardiography. More patients preferred dobutamine (48%) or dipyridamole (40%) echocardiography to adenosine echocardiography (12%; P less than 0.001).

CONCLUSIONS

Dobutamine stress echocardiography is more sensitive and is better tolerated than adenosine or dipyridamole stress echocardiography. Adenosine echocardiography is more specific than dobutamine or dipyridamole echocardiography and is less likely to cause persistent symptoms.