Dobutamine and dipyridamole stress echocardiography in patients with a low incidence of severe coronary artery disease

Background A cardiac risk stratification test that can be performed during operation would be expected to give valuable information for the therapeutic management of patients who need urgent noncardiac surgery. This study was designed to evaluate the feasibility and safety of a dobutamine-atropine stress protocol to detect inducible demand ischemia in anesthetized patients. Methods A standard dobutamine-atropine stress protocol was performed in 80 patients with severe coronary artery disease during fentanyl-isoflurane anesthesia. Biplane transesophageal echocardiography and 12-lead electrocardiography were used to detect induced ischemia. After dobutamine testing, esmolol, nitroglycerin, or both were used to revert ischemia and any hemodynamic changes, as appropriate. Results The protocol detected inducible ischemia or achieved the target heart rate in 75 of the 80 (94%) patients. None of the prospectively defined adverse outcomes, such as cardiovascular collapse, severe ventricular arrhythmia, persistent (> or =5 min) ischemia, or hemodynamic instability, occurred in any of the patients. Ischemia was induced and detected in 73 of the 80 (91%) patients. Conclusion Dobutamine stress echocardiography is feasible in anesthetized patients with severe coronary artery disease. The lack of serious complications and the high sensitivity to detect inducible ischemia in this patient population provide the basis for further evaluation of the safety and diagnostic value of dobutamine stress echocardiography during general anesthesia in larger studies of patients at risk for coronary artery disease undergoing noncardiac surgery.

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Detection of single-vessel coronary artery disease by dipyridamole stress echocardiography: no longer a problem?

Clinical Physiology and Functional Imaging ◽

10.1111/j.1475-097x.2008.00849.x ◽

2009 ◽

Vol 29 (2) ◽

pp. 151-157 ◽

Cited By ~ 2

Author(s):

Piotr Lipiec ◽

Paulina Wejner-Mik ◽

Maria Krzemińska-Pakula ◽

Jacek Kuśmierek ◽

Anna Plachcińska ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Stress Echocardiography ◽

Single Vessel ◽

Vessel Coronary Artery Disease ◽

Artery Disease ◽

Dipyridamole Stress Echocardiography ◽

Dipyridamole Stress ◽

Vessel Coronary Artery

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Speckle-tracking during dipyridamole stress echocardiography in the detection of myocardial ischemia in patients with suspected coronary artery disease

European Heart Journal ◽

10.1093/ehjci/ehaa946.0021 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

L Moderato ◽

G Pastorini ◽

D Lazzeroni ◽

A Monello ◽

G Rusticali ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Stress Echocardiography ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Model Average ◽

Significant Difference ◽

Artery Disease ◽

Dipyridamole Stress Echocardiography ◽

Dipyridamole Stress

Abstract Background The aim of this study was to investigate the incremental value of global longitudinal strain (GLS), postsystolic strain index (PSI) and prestretch (PSE) by automated function imaging with respect to wall motion (WM) and coronary flow reserve (CFR) for the diagnosis of significant coronary artery disease (CAD) during dipyridamole stress echocardiography. Methods We retrospectibely enrolled 227 patients with known or suspected CAD, approaching our echo lab to perform a DSE; all patient underwent coronary angiography within 1 month for clinical reasons. Obstructive CAD was defined as the evidence of >70% stenosis during coronary angiogram. Obstructive CAD was detected in 143 (63%) patients, while 84 (37%) had no significant CAD. Global longitudinal strain, PSI and PSE were measured at rest and peak of the stress (after 6 minutes of 0,84mg/kg of dipyridamole infusion). Results Patient with CAD showed a significantly lower GLS at rest (−16.9±4.2 vs −18.6±3.4; p<0.01) and peak (14.9±3.8 vs −21.50±3.3; p<0.01) Figure A; the behavior of GLS was opposite, in patient with CAD showed an increase while in patient without CAD a significant decrease after dipyridamole infusion. There was also a significant difference between groups for Delta PSI (PSIpeak − PSIrest) and Delta PSE (PSEpeak − PSErest), respectively 126±145 vs −40±97, (p<0.01) and 108±163 vs −41±106 (p<0.01) Figure C. ROC analyses produced a statistically valid model: Average GLS at peak (p 0.001; AUC=0.906, cut-off value −18%, sensitivity 83% and specificity 82%); on the basis of these results, we compared WM and myocardial deformation analysis and GLS was superior to CFR LAD, Delta EF, Delta ESV and Delta WMI (Figure B). Conclusions GLS, PSE and PSI show an opposite response to dipyridamole, in patients with CAD in patient without CAD and show much higher sensitivity and specificity compared to the conventional parameters like WMI, EF and CFR in detecting CAD Funding Acknowledgement Type of funding source: None

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