Gabrielė Čėsnaitė1, Karolina Slapšytė1, Jolanta Justina Vaškelytė2
1Faculty of Medicine of Lithuanian University of Health Sciences, Kaunas, Lithuania;
2Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
Coronary artery disease is the leading cause of death . Hemodynamically significant stenoses are most accurately detected by coronary artery angiography (CAA) examination, but this is an invasive and expensive test .The dobutamine stress echocardiography (DSE) is suitable as a screening method in patients with stable CAD and in asymptomatic patients prior to CAA. DSE is characterized by high sensitivity and specificity, 79-83 % and 82-86 %, respectively .DSE is used to evaluate new load-induced regional contractile disorders in the left ventricle caused by myocardial ischemia .
Methods: Retrospective study enrolled patients with symptoms of CAD admitted to department of cardiology of Kaunas Clinics between July 2017 and February 2019. Data of 389 patients with symptoms of CAD were included in the analysis. The following data was collected: history of comorbidities, body mass index (BMI), DSE, CAA, exercise tolerance test data. The statistical analysis was performed using a standard statistical package SPSS 23.0. Results was compared with Mann-Whitney and χ2 test. Results were considered significant if p<0.05.
Results: 389 clinical cases were investigated, 144 (37%) men and 245 (63%) women. The average age of patients was 67.1±10.3. The poor echocardiography image quality statistically significant often was observed in patients with higher BMI (patiens with ≥ 30 kg/m2 vs. patients < 30 kg/m2 10.3% vs. 3.3%) or atrial fibrillation (patients with AF vs. without AF, 27.5% vs. 7.4%) (p < 0.001). The DSE was done in 87.7% patients and in 12.3% subjects test were discontinued. The DSE results revealed 13.9 % pathological, 70.7 % non-pathological and 15,4% non-informative test results. The CAA was done for 31.4% of all patients. The DSE was false positive in 9 (18%) and false negative in 16 (22.5%) subjects. The agreement between the DSE and CAA finding stenosis were moderate in left anterior descending artery, right coronary artery and was substantial in circumflex artery (Ƙ=0.474, Ƙ=0.583, Ƙ=0.610, respectively, p <0.001). The DSE accuracy is higher in patients with multivessel disease compared with single-vessel disease (75% vs. 10%, respectively, p<0.001). The DSE accuracy was 21.2% (Ƙ=0.189), 50% (Ƙ=0.333) and 83.3% (Ƙ=0.810) in 2016, 2017 and 2018 years, accordingly (p <0.001).
Conclusions: A statistically significant relationship was determined between the patients with AF or higher BMI and poor echocardiography image quality. A statistically significant relationship was observed between b-blocker use prior DSE with not achieved sub-maximal HR. The DSE accuracy is higher to diagnose multivessel disease than single-vessel disease. The match between DSE and CAA is better in diagnosis of circumflex artery stenosis than in anterior interventricular branch and right coronary artery. The accuracy of DSE improved between 2016 and 2018.
Keywords: dobutamine stress echocardiography, coronary artery disease, coronary angiography