San Román J A, Vilacosta I, Castillo J A, Rollán M J, Peral V, Sánchez-Harguindey L, Fernández-Avilés F
Division of Cardiology, Hospital Universitario, Valladolid, Spain.
Chest. 1996 Nov;110(5):1248-54. doi: 10.1378/chest.110.5.1248.
To compare the usefulness of dipyridamole echocardiography, dobutamine-atropine echocardiography, and exercise stress testing in the diagnosis of coronary artery disease and to analyze the agreement among the tests.
Performance of these three tests in random order on a consecutive cohort of patients.
A tertiary care and university center.
One hundred two consecutive patients with chest pain and no history of coronary artery disease.
Dipyridamole echocardiography, dobutamine-atropine echocardiography, exercise stress testing, and coronary angiography.
Dobutamine-atropine test was positive in 49 (77%) of 63 patients with coronary artery disease, dipyridamole test in 49 (77%), and exercise stress test in 44 (68%; p = NS). Both echocardiographic tests showed an overall specificity (dipyridamole, 97%; dobutamine, 95%) higher than exercise stress test (79%; p < 0.05). Sensitivity of dipyridamole testing decreased from 93 to 61% (p = 0.002) if patients were receiving antianginal treatment but sensitivity of dobutamine-atropine testing was not affected (77% in patients receiving and not receiving treatment). When results were considered as positive-negative, agreement between dipyridamole and dobutamine-atropine echocardiography was 85% (kappa = 0.70). With regards to regional analysis, concordance was good (93% for segments, kappa = 0.76; and 95% for coronary arteries, kappa = 0.92). Major complications were more frequent during dobutamine-atropine (n = 7) than during dipyridamole infusion (n = 2) (p = 0.06).
Dobutamine-atropine and dipyridamole echocardiography have a similar sensitivity and a higher specificity than that obtained by exercise ECG for the diagnosis of coronary artery disease. Similar information is obtained with dipyridamole and dobutamine-atropine echocardiography. It is our thought that pharmacologic stress echocardiography should be used as a first-step test to rule out coronary artery disease in patients not capable of exercising.
比较双嘧达莫超声心动图、多巴酚丁胺 - 阿托品超声心动图和运动负荷试验在诊断冠状动脉疾病中的效用，并分析这些检查之间的一致性。
对连续的一组患者按随机顺序进行这三种检查。
一家三级医疗和大学中心。
102例连续的胸痛患者，无冠状动脉疾病史。
双嘧达莫超声心动图、多巴酚丁胺 - 阿托品超声心动图、运动负荷试验和冠状动脉造影。
63例冠状动脉疾病患者中，多巴酚丁胺 - 阿托品试验阳性49例（77%），双嘧达莫试验阳性49例（77%），运动负荷试验阳性44例（68%；p = 无显著性差异）。两种超声心动图检查的总体特异性（双嘧达莫为97%，多巴酚丁胺为95%）均高于运动负荷试验（79%；p < 0.05）。如果患者正在接受抗心绞痛治疗，双嘧达莫试验的敏感性从93%降至61%（p = 0.002），但多巴酚丁胺 - 阿托品试验的敏感性未受影响（接受治疗和未接受治疗的患者中均为77%）。当结果被视为阳性或阴性时，双嘧达莫和多巴酚丁胺 - 阿托品超声心动图之间的一致性为85%（kappa = 0.70）。在区域分析方面，一致性良好（节段为93%，kappa = 0.76；冠状动脉为95%，kappa = 0.92）。多巴酚丁胺 - 阿托品试验期间的主要并发症（n = 7）比双嘧达莫输注期间（n = 2）更常见（p = 0.
