Dipyridamole and Dobutamine-Atropine Stress Echocardiography in the Diagnosis of Coronary Artery Disease

Comparison With Exercise Stress Test, Analysis of Agreement, and Impact of Antianginal Treatment

¹ From the Division of Cardiology, Hospital Universitario, Valladolid, Madrid, Spain
² From the Division of Cardiology, Hospital Universitario San Carlos, Madrid, Spain

Study objectives: 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.

Design: Performance of these three tests in random order on a consecutive cohort of patients.

Setting: A tertiary care and university center.

Patients: One hundred two consecutive patients with chest pain and no history of coronary artery disease.

Interventions: Dipyridamole echocardiography, dobutamine-atropine echocardiography, exercise stress testing, and coronary angiography.

Measurements and results: 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).

Conclusions: 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.

Key Words: coronary artery disease • exercise stress test • stress echocardiography

Submitted on February 1, 1996
Accepted on July 5, 2007

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