Dobutamine stress echocardiography (DSE) is widely used for diagnosis of coronary artery disease (CAD). However, data regarding the diagnosis of coronary artery disease in patients with moderately elevated maximal gradient across the stenosed aortic valve (AS) are limited. This study was designed to the value of DSE in the diagnosis of CAD in women with moderately elevated maximal gradient across the AS.
Patients and methods: DSE was performed in 162 patients within the multicentre study. The group included 58 (mean age 61 +/- 13 years) females and 104 (mean age 58 +/- 13 years) males. DSE was performed with step-wise infusion every three minutes (5, 10, 20, 30 and 40 microg/kg/min). If the target heart rate was not reached, a further dose of 40 mcg/kg/min. together with atropine 0.25-1 mg was administered, in the absence of signs and symptoms of ischemia. Ischaemia was defined as new or worsened wall motion abnormalities at echocardiography. Coronarography was performed according to generally accepted indications. The significant coronary artery disease (>1 = 50% luminal diameter stenosis) of one of the major epicardial vessel was accepted as positive result for making the diagnosis of CAD.
Results: There was significant difference at rest between women and men with regard to left ventricular diastolic diameter (47.7 +/- 6.5 vs 55.6 +/- 8.8 mm), systolic diameter (30.1 +/- 7.9 vs 38.1 +/- 11.5 mm), ejection fraction (67 +/- 12 vs 55 +/- 17%), wall motion score index (1.05 +/- 0.17 vs 1.22 +/- 0.36) p<0.001. There were also a significant difference in left ventricular mass index and diastolic septum diameter (131 +/- 48 vs 152 +/- 46) and (12.5 + 2.7 vs 13.5 +/- 2.6 mm). Dobutamine peak dose was 31 +/- 11 microg/kg/min. The mean heart rate, mean systolic pressure and diastolic pressure were 114 +/- 26/min, 143 +/- 26 and 81 +/- 15 mmHg respectively. Sensitivity, specificity, and accuracy of DSE for the diagnosis of CAD in women were 77.8%, 95.8% and 90.9%. Those in men were 72.7%, 78.8% and 75.6%, respectively (NS).
Conclusion: The diagnostic value of dobutamine stress echocardiography for the diagnosis of coronary artery disease in women with stenosed aortic valve is high. DSE is good method for the diagnosis.