Predictors of multivessel coronary artery disease in dobutamine stress echocardiography

Aims. To assess the ability of dobutamine echocardiography to detect multivessel coronary artery disease and to determine predictive factors for multivessel disease with or without β-blockers. Patients and methods. A total of 101 patients underwent dobutamine stress echocardiography and coronary angiography (evaluation of chest pain 76, extent of coronary disease after myocardial infarction 19, other indications 6). Results. Ten patients in whom the test was prematurely terminated were excluded. Out of 91 patients who underwent dobutamine echocardiography, 54 patients had multivessel disease (sensitivity of dobutamine test 93%, specificity 46%). Heart rate at the maximum dose of dobutamine or atropine was 88 ± 21 beats/min for multivessel diseases and 104 ± 21 beats/min without multivessel disease (p < 0.001). A cut-off value < 94 beats/min discriminated patients at risk for multivessel disease. After adjusting for treatment with β-blockers, heart rate < 94 beats/min, ECG signs of ischemia, and abnormalities on baseline echocardiogram with remote asynergies during dobutamine testing were independent predictors of multivessel disease in the multivariate analysis (probability > 90% when at least two factors were present). Conclusion. A heart rate < 94 beats/min at peak dose of dobutamine or after atropine, ECG signs of ischemia, and the presence of abnormalities on echocardiogram at rest with remote asynergies during dobutamine stress testing were independent predictive factors of multivessel coronary artery disease.