Dobutamine Stress Echocardiography: Is it a Reliable Tool in the Evaluation of Ischaemic Heart Disease?

artery disease (CAD) using noninvasive methods still presents a challenge even today. The classically used methods, such as treadmill stress testing, have a rather low specificity and sensitivity, especially in patients with one-vessel disease, as well as methodological limitations, such as in patients with mobility problems or left bundle branch block. In those patients, drug myocardial scintigraphy with adenosine and dobutamine stress echocardiography provide a good alternative. Particularly in recent years, stress echocardiography has become a widely used examination, whose clinical utility, over the whole spectrum of CAD manifestations, has been well established by a large number of clinical studies. The application of new technologies, such as bharmonics and echo contrast media, has widened its scope and its diagnostic accuracy. Hence, dobutamine stress echocardiography is used for the detection of CAD, for evaluation and prognosis in CAD patients, and for the detection of viable myocardium after myocardial necrosis. More specifically, for the detection of CAD, data from many clinical studies show a sensitivity of 80% and a specificity of 86%, based on angiographic findings. As would be expected, the sensitivity and specificity are lower in patients with onevessel disease, especially in the case of the circumflex and right coronary arteries. However, the specificity of the method is considerably higher than that of perfusion scintigraphy, especially in patients with left ventricular hypertrophy and in women (smaller left ventricle, technical errors from the presence of the breasts in the scintigraphic examination). As regards the prognosis of patients with suspected or known CAD, dobutamine stress echocardiography provides exceptionally valuable information. In those patients, a negative stress echo examination is associated with a one-year mortality rate of 0.4-1.05%. Finally, in the assessment of myocardial viability, after either myocardial infarction or reperfusion interventions, low-dose dobutamine stress echo has a high sensitivity (53-87%) and specificity (85-95%). This specificity is again considerably higher than that of scintigraphy with either thallium or technetium, given that scintigraphy detects small viable regions that do not, however, contribute to myocardial contractility, while it is doubtful to what extent their viability plays a part in survival. Positron emission tomography, an examination that is not widely available but has been used in recent years for the diagnosis of CAD, does not seem to provide more information than dobutamine stress echo for the detection of CAD or viable myocardium,