Dobutamine stress test to diagnose the presence and severity of coronary artery lesions in angina

• Published in: European heart journal Vol. 12; no. 11; p. 1198
• Main Author: Coma-Canella, I
• Format: Journal Article
• Language: English
• Published: England 01.11.1991
• Subjects: Adult; Aged; Angina Pectoris - etiology; Blood Pressure; Coronary Angiography; Coronary Artery Disease - complications; Coronary Artery Disease - diagnosis; Coronary Artery Disease - diagnostic imaging; Dobutamine - administration & dosage; Electrocardiography; Female; Heart Rate; Humans; Male; Middle Aged; Predictive Value of Tests; Sensitivity and Specificity; Severity of Illness Index
• ISSN: 0195-668X
• DOI: 10.1093/eurheartj/12.11.1198

To calculate the accuracy of dobutamine infusion as a stress test to detect coronary lesions, 90 patients with angina and nine asymptomatic subjects with nonsignificant coronary lesions were submitted to a dobutamine test and coronary arteriography. Dobutamine was given in doses of 5, 10, 15 and 20 micrograms kg-1 min-1 every 5 min; a 12 lead ECG and blood pressure was monitored. Pressure x rate product increased from 8240 +/- 1667 to 14,898 +/- 3042. The test was negative (neither angina pain, nor ST segment shift) in 31 patients, and positive in 68. The ST segment was depressed in 33 cases and elevated in 20. Significant (greater than or equal to 50%) coronary lesions were seen in 63 patients and functional (coronary spasm or vasoconstriction) abnormalities in six. The sensitivity of the dobutamine test for the detection of coronary lesions was 95%, specificity 78%, predictive value of a positive test 88%, of a negative test 90% and diagnostic efficiency 89%. Strongly positive tests predicted severe lesions in 91% of the cases, and slightly positive tests ruled out severe lesions in 84%. ST segment elevation was induced in 20 cases and corresponded to a severe coronary lesion. In conclusion, the dobutamine stress test is a simple and accurate method of predicting coronary artery disease in patients with angina, distinguishing between severe and mild lesions. It can be a good alternative to an exercise test.