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Diagnostic Results and Indications

  • Chapter
Stress Echocardiography

Abstract

The relationship between the data obtained from provocative tests and angiographically assessed coronary artery disease is usually expressed in terms of sensitivity (the frequency of a positive test result in a population of patients with coronary artery disease) and specificity (the frequency of a negative test result in a population of patients without disease). This game can be played in very different ways, since the values of sensitivity and specificity in a given population are affected by a constellation of factors, some of which — more relevant to stress echocardiography — are summarized in Tables 1 and 2. These factors are related to the patient population, angiographic standard, stress methodology, and criteria of interpretation. Any stress echocardiography test gives higher values of sensitivity in the presence of more severe and extensive coronary artery disease. For any given level of stenosis, vasodilator stresses [2], but not inotropic stresses [3], are associated with higher sensitivity with angiographic coronary lesions of the “complex” type (i. e., with intraluminal filling defects and/or irregular margins suggestive of thrombus and/or ulcers) [2]. Angiographically assessed good coronary collateral circulation makes the myocardium more vulnerable to ischemia during vasodilator stresses [4], whereas exercise or inotropic stresses results are independent of angiographically assessed collateral circulation [5].

No test is so good that you cannot make it look bad; no test is so bad that you cannot make it look good

(Marco Antonio Torres [i])

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References

  1. Torres MA (1996) Stress echocardiography for diagnosis of coronary artery disease (letter). J Am Coll Cardiol 27: 514

    Article  PubMed  CAS  Google Scholar 

  2. Lu C, Picano E, Pingitore A, Sicari R, Tongiani R, Baratto M, Palmieri C, Marzilli M, L’Abbate A (1995) Complex coronary artery lesion morphology influences results of stress echocardiography. Circulation 91: 1669–1675

    Article  PubMed  CAS  Google Scholar 

  3. Heyman J, Salvadè P, Picano E, Varga A, Ghliozeni E, Sicari R, Previtali M, Rovelli G (1997) The elusive link between coronary lesion morphology and dobutamine stress echocardiography results. Int J Cardiac Imaging (in press)

    Google Scholar 

  4. Gliozheni E, Picano E, Bernardino L, Pingitore A, Sicari R, Marzilli M (1996) Angiographically assessed coronary collateral circulation increases vulnerability to myocardial ischemia during vasodilator stress testing. Am J Cardiol 78: 1419–1424

    Article  PubMed  CAS  Google Scholar 

  5. Ramani K, Davidson CJ, Chaudhny FA (1996) Do coronary collaterals protect against ischemia duing stress echocardiography? Circulation [Suppl]: I - 141

    Google Scholar 

  6. Marwick T, Willemart B, D’Hondt AM et al. (1993) Selection of the optimal non-exercise stress for the evaluation of ischemic regional myocardial dysfunction and malperfusion: comparison of dobutamine and adenosine using echocardiography and Tc-99 m MIBI single photon emission computed tomography. Circulation 87: 345–354

    Article  PubMed  CAS  Google Scholar 

  7. Severi S, Picano E, Michelassi C, Lattanzi F, Landi P, Distante A, L’Abbate A (1994) Diagnostic and prognostic value of dipyridamole echocardiography in patients with suspected coronary artery disease: comparison with exercise electrocardiography. Circulation 89: 1160–1173

    Article  PubMed  CAS  Google Scholar 

  8. Marwick T, d’Hondt A, Baudhuin T et al. (1993) Optimal use of dobutamine stress for the detection and evaluation of coronary artery disease: combination with echocardiography, scintigraphy or both? J Am Coll Cardiol 22: 159–167

    Article  PubMed  CAS  Google Scholar 

  9. Parodi G, Marcassa C, Picano E, Marzullo P, Verna E, Bisi G, Galli M, Pirelli S, Sambuceti G, Parodi O (1997) High dose dipyridamole stress imaging: comparison of Sestamibi scintigraphy and 2D-echocardiography for the detection of coronary artery disease. A multicenter study. J Am Coll Cardiol [Suppl] 29: 441A (abstr)

    Google Scholar 

  10. Quinones MA,Verani MS, Haichin RM, Mahamarian JJ, Suarez J, Zoghbi WA (1992) Exercise echocardiography versus Tl-2o1 single photon emission computed tomography in evaluation of coronary artery disease. Analysis of 292 patients. Circulation 85: 1026–1031

    Google Scholar 

  11. Fung AY, Gallagher KP, Buda AJ (1987) The physiologic basis of dobutamine as compared with dipyridamole stress interventions in the assessment of critical coronary stenosis. Circulation 16: 1375–1383

    Google Scholar 

  12. Segar DS, Ryan T, Sawada SG, Johnson M, Feigenbaum H (1995) Pharmacologically induced myocardial ischemia: a comparison of dobutamine and dipyridamole. J Am Soc Echocardiogr 8: 9–14

    Article  PubMed  CAS  Google Scholar 

  13. Paulsen PR, Pavek T, Crampton M et al. (1992) Which stress is best? Exercise, dobutamine, dipyridamole and pacing in animal model. J Am Coll Cardiol 70: 252–256

    Article  Google Scholar 

  14. Martin TW, Seaworth JF, Johns JP, Pupa LE, Condos WR (1992) Comparison of adenosine, dipyridamole and dobutamine in stress echocardiography. Ann Intern Med 116: 190–196

    PubMed  CAS  Google Scholar 

  15. Salustri A, Fioretti PM, McNeil AJ, Pozzoli MMA, Roelandt JRTC (1992) Pharmacological stress echocardiography in the diagnosis of coronary artery disease and myocardial ischemia: a comparison between dobutamine and dipyridamole. Eur Heart J 13: 1356–1362

    PubMed  CAS  Google Scholar 

  16. Previtali M, Lanzarini L, Fetiveau R, Poli A, Ferrario M, Falcone C, Mussini A (1993) Comparison of dobutamine stress echocardiography, dipyridamole stress echocardiography and exercise stress testing for diagnosis of coronary artery disease. Am J Cardiol 72: 865–870

    Article  PubMed  CAS  Google Scholar 

  17. Beleslin BD, Ostojic M, Stepanovic J, Djordjevic-Dikic A, Stojkovic S, Babic R, Nedeljkovic M, Stankovic G, Petrasinovic Z, Gojkovic L, Vasiljevic-Pokrajcic Z (1994) Stress echocardiography in the diagnosis of detection of ischemic heart disease: head-to-head comparison between exercise, dobutamine and dipyridamole tests. Circulation 90: 1168–1176

    Article  PubMed  CAS  Google Scholar 

  18. Gruber N, Varga A, Forster T, Varga L, Borthaiser A, Csanady M (1994) Comparative evaluation of dipyridamole and dobutamine two-dimensional echocardiography in ischemic heart disease. Ory Hetil 135: 67–70

    CAS  Google Scholar 

  19. Dagianti A, Penco M,Agati L, Sciomer S, Dagianti A, Rosanio S, Fedele F (1995) Stress echocardiography: comparison of exercise, dipyridamole and dobutamine in detecting and predicting the extent of coronary artery disease. J Am Coll Cardiol 26: 18–25

    CAS  Google Scholar 

  20. Sochowski RA, Yvorchuck KJ, Yang Y (1995) Dobutamine and dipyridamole stress echocardiography in patients with a low incidence of coronary artery disease. J Am Soc Echocardiogr 8: 482–487

    Article  PubMed  CAS  Google Scholar 

  21. San Roman JA, Villacosta I, Castillo JA (1996) Dipyridamole and dobutamine-atropine stress echocardiography in the diagnosis of coronary artery disease. Comparison with exercise stress test, analysis of agreement and impact on antianginal treatment. Chest no: 1248–1254

    Google Scholar 

  22. Pingitore A, Picano E, Quartacolosso M et al. (1996) The atropine factor in pharmacological stress echocardiography. J Am Coll Cardiol 27: 1164–1170

    Article  PubMed  CAS  Google Scholar 

  23. Nedeljikovic I, Ostojic M, Vukovic B et al. (1996) Stress echocardiography: comparison of exercise, dipyridamole-atropine and dobutamine-atropine in detecting coronary artery disease. Eur Heart J [Abstr Suppl] 17: 205

    Article  Google Scholar 

  24. Schroeder K, Voller H, Dingerkus H et al. (1996) Comparison of the diagnostic potential of four echocardiographic stresses shortly after acute myocardial infarction: submaximal exercise, transesophageal atrial pacing, dipyridamole and dobutamine-atropine. Am J Cardiol 77: 909–914

    Article  Google Scholar 

  25. Schroeder K, Wieckhorst A, Voller H (1997) Head-to-head comparison of the prognostic value of dipyridamole-and dobutamine-stress echocardiography (to be published )

    Google Scholar 

  26. Pingitore A, Gigli G, Bigi R, Lowenstein J, Mathias W, Coletta C, Minardi G, Quarta Colosso C, Raciti M, Landi P, Picano E (1996) The relative prognostic value of dobutamine vs dipyridamole stress in patients with known or suspected coronary artery disease. Circulation [Suppl I] 94 (8): I - 678

    Google Scholar 

  27. Minardi G, Di Segni M, Manzara CC, Pulignano G, Chiantera A, De Santis F, Armiento G, Vajola FS, Giovannini E (1997) Diagnostic and prognostic value of dipyridamole and dobutamine stress echocardiography in patients with acute myocardial infarction. Am J Cardiol (in press)

    Google Scholar 

  28. Poli A, Previtali M, Lanzarini L et al. (1996) Comparison of dobutamine stress echocardiography with dipyridamole stress echocardiography for detection of viable myocardium after myocardial infarction treated with thrombolysis. Heart 75: 240–246

    Article  PubMed  CAS  Google Scholar 

  29. Picano E, Ostojic M, Varga A, Sicari R, Djordjevic-Dikic A, Nedeljkovic I, Torres M (1996) Combined low dose dipyridamole-dobutamine stress echocardiography to identify myocardial viability. J Am Coll Cardiol 27: 142–148

    Article  Google Scholar 

  30. Ostojic M, Picano E, Beleslin B, Djordjevic-Dikic A, Distante A, Stepanovic J, Reisenhofer B, Babic R, Stojkovic S, Nedeljkovic M, Stankovic G, Simeunovic S, Kanjuh V (1994) Dipyridamole-dobutamine echocardiography: a novel test for the detection of milder forms of coronary artery disease. J Am Coll Cardiol 23 (5): 1115–1122

    Article  PubMed  CAS  Google Scholar 

  31. Marwick TH, D’Hondt AM, Mairesse GH, Baudhuin T, Wijns W, Detry JM, Melin JA (1994) Comparative ability of dobutamine and exercise stress in inducing myocardial ischemia in active patients. Br Heart J 72: 31–38

    Article  PubMed  CAS  Google Scholar 

  32. Cohen JL, Ottenweller JE, Achenkunju KG, Srinivas D (1993) Comparison of dobutamine and exercise echocardiography for detecting coronary artery disease. Am J Cardiol 72: 1226–1231

    Article  PubMed  CAS  Google Scholar 

  33. Attenhofer CH, Pellikka PA, Oh JK, Roger VL, Sohn DW, Seward JB (1996) Comparison of ischemic response during exercise and dobutamine echocardiography in patients with left main coronary artery disease. J Am Coll Cardiol 27 (5): 1171–1177

    Article  PubMed  CAS  Google Scholar 

  34. Marangelli V, Iliceto S, Piccinni G, De Martino G, Sorgente L, Rizzon P (1994) Detection of coronary artery disease by digital stress echocardiography: comparison of exercise, transesophageal atrial pacing, and dipyridamole echocardiography. J Am Coll Cardiol 24: 117–124

    Article  PubMed  CAS  Google Scholar 

  35. Hirano Y, Yamamoto T, Sasaki T et al. (1995) Diagnosis of ischemic heart disease by dipyridamole echocardiography: a comparison with exercise echocardiography. Jpn J Med Ultrasonics 8: 5–12

    Google Scholar 

  36. Bjornstad IL, Dakhers S, Hatle L (1995) Comparison of digital dipyridamole stress echocardiography and upright bicycle stress echocardiography for identification of coronary artery stenosis. Cardiology 86: 514–520

    Article  PubMed  CAS  Google Scholar 

  37. Deutsch HJ, Schekel C, Klaer R, Curtius JM (1994) Comparison of ergometer and dipyridamole echocardiography in patients with suspected coronary heart disease. Z Kardiol 83 (6): 446–453

    PubMed  CAS  Google Scholar 

  38. Picano E, Lattanzi F, Masini M, Distante A, L’Abbate A (1987) Comparison of high-dose dipyridamole-echocardiography test and exercise 2D echocardiography for diagnosis of coronary artery disease. Am J Cardiol 59: 539–542

    Article  PubMed  CAS  Google Scholar 

  39. Picano E, Parodi O, Lattanzi F, Sambuceti G, Masini M, Marzullo P, Distante A, L’Abbate A (1989) Comparison of dipyridamole-echocardiography test and exercise thallium-2o1 scanning for diagnosis of coronary artery disease. Am J Noninv Cardiol 3: 85–92

    Google Scholar 

  40. Pirelli S, Danzi GB, Alberti A, Massa D, Piccalò G, Faletra F, Picano E, Campolo L, De Vita C (1991) Comparison of usefulness of high dose dipyridamole echocardiography and exercise electrocardiography for detection of asymptomatic restenosis after coronary angioplasty. Am J Cardiol 67: 1335–1338

    Article  PubMed  CAS  Google Scholar 

  41. Marwick TH, Namec JJ, Paschow FJ et al. (1992) Accuracy and limitations of exercise echocardiography in a routine clinical setting. J Am Coll Cardiol 19: 74–8o

    Article  PubMed  CAS  Google Scholar 

  42. Lattanzi F, Picano E, Bolognese L, Piccinino C, Sarasso G, Orlandini A, L’Abbate A (1991) Inhibition of dipyridamole-induced ischemia by antianginal therapy in humans. Correlation with exercise electrocardiography. Circulation 83: 1256–1262

    Google Scholar 

  43. Ferrara N, Coltorti F, Lesco D et al (1995) Protective effects of beta-blockade on dipyridamole-induced myocardial ischemia. Role of heart rate. Eur Heart J 16: 903–908

    Google Scholar 

  44. Ferrara N, Longobardi G, Nicolino A et al. (1992) Effect of beta-adrenoreceptor blockade on dipyridamole-induced myocardial asynergies in coronary artery disease. Am J Cardiol 70: 724–727

    Article  PubMed  CAS  Google Scholar 

  45. Longobardi G, Ferrara N, Leosco D et al. (1995) Failure of protective effect of captopril and enalapril on exercise and dipyridamole-induced myocardial ischemia. Am J Cardiol 76: 255–258

    Article  PubMed  CAS  Google Scholar 

  46. Fioretti PM, Poldermans D, Salustri A, Forster T, Boersma E, McNeill AJ, El-Said M, Roelandt JRTC (1994) Atropine increases the accuracy of dobutamine stress echocardiography in patients taking beta blockers. Eur Heart J 15 (3): 355–36o

    Article  PubMed  CAS  Google Scholar 

  47. Dodi C, Pingitore A, Sicari R, Bruno G, Cordovil A, Picano E (1997) Effects of antianginal therapy with calcium-antagonist and nitrates on dobutamine-atropine stress echocardiography: comparison with exercise-electrocardiography. Eur Heart J 18: 242–247

    Article  PubMed  CAS  Google Scholar 

  48. Varga A, Preda I (1997) Pharmacological stress echocardiography for exercise-independent assessment of anti-ischemic therapy. Eur Heart J 18:18o -181

    Google Scholar 

  49. Cheitlin MS, Alpert JS, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ, Davidson TW, Davis JL, Douglas PS, Gillam LD, Lewis RP, Pearlman AS, Philbrick JY, Shah PM, Williams RG (1997) ACC/AHA guidelines for the clinical application of echocardiography: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines ( Committee on Clinical Application of Echocardiography ). J Am Coll Cardiol 29: 862–879

    Google Scholar 

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Authors and Affiliations

  1. Institute of Clinical Physiology, CNR, Via Paolo Savi, 8, I-56126, Pisa, Italy

    Eugenio Picano MD, PhD, FESC

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  1. Eugenio Picano MD, PhD, FESC
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© 1997 Springer-Verlag Berlin Heidelberg

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Picano, E. (1997). Diagnostic Results and Indications. In: Stress Echocardiography. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-10090-5_19

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  • DOI: https://doi.org/10.1007/978-3-662-10090-5_19

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-10092-9

  • Online ISBN: 978-3-662-10090-5

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