[The echo-dobutamine test for the diagnosis of myocardial ischemia. Study on 20 patients with normal kinetics at rest]

We have assessed the value of dobutamine stress echocardiography for the diagnosis of myocardial ischemia in 20 consecutive patients referred for chest pain, without a previous myocardial infarction and with a normal left ventricular wall motion at rest. The test was considered positive when wall motion abnormalities appeared during dobutamine infusion (from 5 to a maximum of 40 micrograms/Kg/min). The results were compared to the % diameter stenosis (%DS) quantitatively measured on coronary arteriography. "Significant" coronary artery disease was defined as greater than or equal to 50% DS. No significant side effects occurred in any patients during the test. Transient wall motion abnormalities were detected in 8 of the 12 patients with significant coronary artery disease (sensitivity = 66%) and in 1 of the 8 patients without significant coronary artery disease (specificity = 88%). All the patients with false-negative dobutamine stress echocardiography had distal stenosis or stenosis in a collateral vessel; moreover, all the patients with true-positive dobutamine stress echocardiography had proximal (7 patients) or middle (1 patient) stenosis. The results of this study show that dobutamine stress echocardiography is a safe and feasible test for the noninvasive diagnosis of myocardial ischemia.