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      Assessment of the Functional Significance of Coronary Artery Stenosis by Dobutamine-Atropine Stress Echocardiography

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          Abstract

          This study was performed to evaluate whether dobutamine stress echocardiography (DSE) can provide any additional information regarding the location and severity of coronary artery disease (CAD) in an individual patient. DSE was performed in 233 patients with clinical manifestations of angina pectoris. There were 162 patients with angiographically documented CAD defined as ≧ 50% diameter stenosis. The severity of coronary lesions was divided into three groups: 50-75, 76-90 and > 90%. The diagnostic sensitivity in detecting left anterior descending artery (LAD) and right coronary artery (RCA) lesions was higher for lesion severity of > 90% than of 50-75% (p = 0.01 for LAD and p < 0.05 for RCA). The diagnostic sensitivity in detecting CAD was highest among patients with proximal coronary lesions (89% for LAD, 64% for the left circumflex artery, and 81 % for the RCA). When lesion severity increased from 50-75 to > 90%, wall motion scores at peak dose during dobutamine infusion increased from 12.3 ± 4.3 to 18.4 ± 5.4 (p = 0.003) in the proximal LAD lesion group and from 10.6 ± 2.0 to 20.4 ± 5.9 (p < 0.0001) in the mid-distal LAD lesion group. When lesion severity increased from 50-75 to > 90%, wall motion scores at peak dose increased from 5.9 ± 2.0 to 8.0 ± 2.5 (p < 0.05) in the proximal RCA lesion group and from 5.2 ± 2.1 to 8.1 ± 1.9 (p < 0.05) in the mid RCA lesion group. However, the change in wall motion scores did not reach statistical significance in proximal and distal lesions of the left circumflex artery when lesion severity increased from 50-75 to > 90%. The correlation coefficient between quantitative wall motion score and Gensini’s score was 0.54 (p = 0.0001) in all patients and 0.6 (p = 0.0001) in patients without myocardial infarction. In conlcusion, the functional significance of lesion severity and distribution can be evaluated by DSE. Regional dyssynergy of LAD and RCA territories during peak-dose dobutamine infusion was most apparent at the stenotic level > 90%.

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          Author and article information

          Journal
          CRD
          Cardiology
          10.1159/issn.0008-6312
          Cardiology
          S. Karger AG
          0008-6312
          1421-9751
          1997
          1997
          19 November 2008
          : 88
          : 4
          : 386-392
          Affiliations
          Department of Internal Medicine (Cardiology), National Taiwan University Hospital, Taipei, Taiwan
          Article
          177364 Cardiology 1997;88:386–392
          10.1159/000177364
          9197435
          © 1997 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Pages: 7
          Categories
          Noninvasive and Diagnostic Cardiology

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