TY - JOUR
T1 - Acute beta blockade at peak stress
T2 - Will it alter the sensitivity of dobutamine stress echocardiography in patients with normal resting wall motion?
AU - Abdel-Salam, Zainab
AU - Ghazy, Mohamed
AU - Khaled, Mohamed
AU - Nammas, Wail
PY - 2016/1
Y1 - 2016/1
N2 - Background: We compared the accuracy of recovery phase images following administration of intravenous propranolol with peak stress images, for detection of coronary artery disease in patients with no resting wall motion abnormalities undergoing dobutamine stress echocardiography. Methods: We enrolled 100 consecutive patients with no resting wall motion abnormalities who underwent dobutamine stress echocardiography. Propranolol was injected after termination of dobutamine infusion. Positive peak stress images were defined as the induction of wall motion abnormalities at any stage before propranolol injection. Positive recovery phase images were defined asmaintenance or worsening of wallmotion abnormalities induced at peak stress, or the appearance of new wall motion abnormalities during recovery phase. Significant coronary stenosis was defined as ≤ 50% obstruction of ≤ 1 sizable artery by coronary angiography. Results: Seventy-two patients (72%) had significant coronary artery disease. Analysis of peak stress images revealed sensitivity, specificity, positive and negative predictive values of 80.6%, 85.7%, 93.5%, and 63.2%; the overall accuracy was 82%. Analysis of the recovery phase images revealed sensitivity, specificity, positive and negative predictive values of 91.7%, 75%, 90.4%, and 77.8%; here, the overall accuracy was 87%. Conclusions: In patients with no resting wall motion abnormalities, acute beta blockade during dobutamine stress echocardiography improved the sensitivity of recovery phase images for detection of significant coronary artery disease versus peak stress images, but with reduced specificity.
AB - Background: We compared the accuracy of recovery phase images following administration of intravenous propranolol with peak stress images, for detection of coronary artery disease in patients with no resting wall motion abnormalities undergoing dobutamine stress echocardiography. Methods: We enrolled 100 consecutive patients with no resting wall motion abnormalities who underwent dobutamine stress echocardiography. Propranolol was injected after termination of dobutamine infusion. Positive peak stress images were defined as the induction of wall motion abnormalities at any stage before propranolol injection. Positive recovery phase images were defined asmaintenance or worsening of wallmotion abnormalities induced at peak stress, or the appearance of new wall motion abnormalities during recovery phase. Significant coronary stenosis was defined as ≤ 50% obstruction of ≤ 1 sizable artery by coronary angiography. Results: Seventy-two patients (72%) had significant coronary artery disease. Analysis of peak stress images revealed sensitivity, specificity, positive and negative predictive values of 80.6%, 85.7%, 93.5%, and 63.2%; the overall accuracy was 82%. Analysis of the recovery phase images revealed sensitivity, specificity, positive and negative predictive values of 91.7%, 75%, 90.4%, and 77.8%; here, the overall accuracy was 87%. Conclusions: In patients with no resting wall motion abnormalities, acute beta blockade during dobutamine stress echocardiography improved the sensitivity of recovery phase images for detection of significant coronary artery disease versus peak stress images, but with reduced specificity.
KW - Accuracy
KW - Beta blocker
KW - Coronary artery disease
KW - Dobutamine stress echocardiography
KW - Recovery phase images
UR - http://www.scopus.com/inward/record.url?scp=84955239311&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84955239311&partnerID=8YFLogxK
U2 - 10.6515/ACS20150204D
DO - 10.6515/ACS20150204D
M3 - Article
AN - SCOPUS:84955239311
SN - 1011-6842
VL - 32
SP - 89
EP - 95
JO - Acta Cardiologica Sinica
JF - Acta Cardiologica Sinica
IS - 1
ER -