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Mechanisms of regional wall motion abnormalities in contrast-enhanced Dobutamine Stress Echocardiography

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Summary

Background

In the diagnosis of coronary artery disease (CAD) with Dobutamine Stress Echocardiography (DSE), regional wall motion abnormalities (RWMA) are assumed to indicate a perfusion deficit.

Methods and results

For a more particular examination of RWMAs, we compared simultaneous echo-contrast (Optisone®)-enhanced DSE (0–40 µg/kg Dobutamine, 16-segment- model) and MiBi-SPECT in a prospective double-blinded study design in 69 non-selected consecutive patients (44 male, 25 female, age 64±12 years). Additionally, all patients were examined by coronary-angiography. The prevalence of significant CAD (stenosis >50% lumen diameter) was 52%. DSE had a sensitivity of 78% and a specificity of 66% for the detection of significant CAD with a positive and negative predictive value of 72 and 73%, respectively. Among 28 patients with significant CAD and positive DSE study (true positive), 78% displayed a corresponding perfusion deficit in MiBi-SPECT. Among 11 patients with a positive DSE study but no current significant coronary stenosis (false positive), 82% showed stress-induced RWMAs in the inferior/ posterior region, 73% displayed left ventricular hypertrophy, 54% resting-ECG abnormalities and 45% resting-RWMA (3 previous MI, 2 previous CABG surgery). Among 8 patients with negative DSE study but significant coronary stenosis (false negative), 75% had a stenosis of the LCX, 63% displayed resting- WMA, 63% displayed left bundle branch block or ST-segment depression, 50% displayed only peripheral coronary stenosis, and DSE visualization was suboptimal in 38%.

Conclusion

This prospective study in non-selected patients shows that the majority of RWMAs in DSE are matched to a perfusion deficit detectable by nuclear imaging. Nevertheless, pre-existing cardiac abnormalities may also lead to stress-induced RWMA not associated with a perfusion deficit or mask a perfusion deficit upon DSE. Particularly in patients with LV hypertrophy, resting-RWMA, bundle branch block or ST segment depression, the predictive value of DSE may, therefore, be limited.

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Authors and Affiliations

  1. Klinik und Poliklinik für Innere Medizin II, University of Regensburg, 93042, Regensburg, Germany

    Norbert Heinicke MD, Bernhard Benesch MD, Tanja Kaiser MD, Kurt Debl MD, Günter A. J. Riegger MD, Stephan Holmer MD & Andreas Luchner MD

  2. Klinik und Poliklinik für Innere Medizin II, Abteilung für Nuklearmedizin, University of Regensburg, Regensburg, Germany

    Mark Segmüller MD, J. Schönberger, Jörg Marienhagen MD & Christoph Eilles MD

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  1. Norbert Heinicke MD
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  2. Bernhard Benesch MD
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  3. Tanja Kaiser MD
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Correspondence to Norbert Heinicke MD.

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Heinicke, N., Benesch, B., Kaiser, T. et al. Mechanisms of regional wall motion abnormalities in contrast-enhanced Dobutamine Stress Echocardiography. Clin Res Cardiol 95, 650–656 (2006). https://doi.org/10.1007/s00392-006-0443-2

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  • DOI: https://doi.org/10.1007/s00392-006-0443-2

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