Usefulness and limitations of dobutamine-atropine stress echocardiography for the diagnosis of coronary artery disease in patients with left bundle branch block a multicentre study

M. L. Geleijnse, C. Vigna, J. D. Kasprzak, R. Rambaldi, M. P. Salvatori, A. Elhendy, J. H. Cornel, P. M. Fioretti, J. R T C Roelandt

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

Background: Patients with left bundle branch block exhibit abnormal septal motion which may limit the interpretation of stress echocardiograms. This study sought to assess the diagnostic value of dobutamine-atropine stress echocardiography in left bundle branch block patients. Methods and Results: Sixty-four left bundle branch block patients (mean age 59 years, 24 men) with suspected coronary artery disease underwent dobutamine-atropine stress echocardiography and coronary arteriography. Myocardial ischaemia was defined as new or worsening wall thickening abnormalities. Coronary artery disease was quantitatively defined as a diameter stenosis ≥50% in a major epicardial artery. Rest septal motion was normal (apart from the early systolic septal notch) in 34 patients (53%) and abnormal in 30 patients (47%). Rest septal thickening was normal in 32 patients (50%) and abnormal in 32 patients (50%). All seven patients with a QRS duration ≥ 160 ms and an abnormal QRS axis had abnormal rest septal motion and thickening. Inter-observer agreement for ischaemia was 88%. In all but one patient disagreement was in the septum. For the anterior and posterior circulation, respectively, sensitivity was 60% (9/15) and 67% (8/12), specificity was 94% (46/49) and 98% (51/52), and accuracy was 86% (55/64) and 92% (59/64). Sensitivity for the anterior circulation tended to be better in patients with normal rest septal thickening (83% vs 44%). Conclusions: Dobutamine-atropine stress echocardiography has excellent diagnostic specificity in left bundle branch block patients with suspected coronary artery disease. In patients with abnormal rest septal thickening, however, dobutamine-atropine stress echocardiography may lack good sensitivity for detection of coronary artery disease in the anterior circulation. Left bundle branch block patients who potentially most benefit from dobutamine-atropine stress echocardiography may initially be selected by their resting electrocardiogram. (C) 2000 The European Society of Cardiology.

Original languageEnglish
Pages (from-to)1666-1673
Number of pages8
JournalEuropean Heart Journal
Volume21
Issue number20
DOIs
Publication statusPublished - 2000

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Stress Echocardiography
Bundle-Branch Block
Atropine
Multicenter Studies
Coronary Artery Disease
Myocardial Ischemia

Keywords

  • Coronary artery disease
  • Dobutamine
  • Left bundle branch block
  • Stress echocardigraphy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Usefulness and limitations of dobutamine-atropine stress echocardiography for the diagnosis of coronary artery disease in patients with left bundle branch block a multicentre study. / Geleijnse, M. L.; Vigna, C.; Kasprzak, J. D.; Rambaldi, R.; Salvatori, M. P.; Elhendy, A.; Cornel, J. H.; Fioretti, P. M.; Roelandt, J. R T C.

In: European Heart Journal, Vol. 21, No. 20, 2000, p. 1666-1673.

Research output: Contribution to journalArticle

Geleijnse, ML, Vigna, C, Kasprzak, JD, Rambaldi, R, Salvatori, MP, Elhendy, A, Cornel, JH, Fioretti, PM & Roelandt, JRTC 2000, 'Usefulness and limitations of dobutamine-atropine stress echocardiography for the diagnosis of coronary artery disease in patients with left bundle branch block a multicentre study', European Heart Journal, vol. 21, no. 20, pp. 1666-1673. https://doi.org/10.1053/euhj.1999.2008
Geleijnse, M. L. ; Vigna, C. ; Kasprzak, J. D. ; Rambaldi, R. ; Salvatori, M. P. ; Elhendy, A. ; Cornel, J. H. ; Fioretti, P. M. ; Roelandt, J. R T C. / Usefulness and limitations of dobutamine-atropine stress echocardiography for the diagnosis of coronary artery disease in patients with left bundle branch block a multicentre study. In: European Heart Journal. 2000 ; Vol. 21, No. 20. pp. 1666-1673.
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abstract = "Background: Patients with left bundle branch block exhibit abnormal septal motion which may limit the interpretation of stress echocardiograms. This study sought to assess the diagnostic value of dobutamine-atropine stress echocardiography in left bundle branch block patients. Methods and Results: Sixty-four left bundle branch block patients (mean age 59 years, 24 men) with suspected coronary artery disease underwent dobutamine-atropine stress echocardiography and coronary arteriography. Myocardial ischaemia was defined as new or worsening wall thickening abnormalities. Coronary artery disease was quantitatively defined as a diameter stenosis ≥50{\%} in a major epicardial artery. Rest septal motion was normal (apart from the early systolic septal notch) in 34 patients (53{\%}) and abnormal in 30 patients (47{\%}). Rest septal thickening was normal in 32 patients (50{\%}) and abnormal in 32 patients (50{\%}). All seven patients with a QRS duration ≥ 160 ms and an abnormal QRS axis had abnormal rest septal motion and thickening. Inter-observer agreement for ischaemia was 88{\%}. In all but one patient disagreement was in the septum. For the anterior and posterior circulation, respectively, sensitivity was 60{\%} (9/15) and 67{\%} (8/12), specificity was 94{\%} (46/49) and 98{\%} (51/52), and accuracy was 86{\%} (55/64) and 92{\%} (59/64). Sensitivity for the anterior circulation tended to be better in patients with normal rest septal thickening (83{\%} vs 44{\%}). Conclusions: Dobutamine-atropine stress echocardiography has excellent diagnostic specificity in left bundle branch block patients with suspected coronary artery disease. In patients with abnormal rest septal thickening, however, dobutamine-atropine stress echocardiography may lack good sensitivity for detection of coronary artery disease in the anterior circulation. Left bundle branch block patients who potentially most benefit from dobutamine-atropine stress echocardiography may initially be selected by their resting electrocardiogram. (C) 2000 The European Society of Cardiology.",
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T1 - Usefulness and limitations of dobutamine-atropine stress echocardiography for the diagnosis of coronary artery disease in patients with left bundle branch block a multicentre study

AU - Geleijnse, M. L.

AU - Vigna, C.

AU - Kasprzak, J. D.

AU - Rambaldi, R.

AU - Salvatori, M. P.

AU - Elhendy, A.

AU - Cornel, J. H.

AU - Fioretti, P. M.

AU - Roelandt, J. R T C

PY - 2000

Y1 - 2000

N2 - Background: Patients with left bundle branch block exhibit abnormal septal motion which may limit the interpretation of stress echocardiograms. This study sought to assess the diagnostic value of dobutamine-atropine stress echocardiography in left bundle branch block patients. Methods and Results: Sixty-four left bundle branch block patients (mean age 59 years, 24 men) with suspected coronary artery disease underwent dobutamine-atropine stress echocardiography and coronary arteriography. Myocardial ischaemia was defined as new or worsening wall thickening abnormalities. Coronary artery disease was quantitatively defined as a diameter stenosis ≥50% in a major epicardial artery. Rest septal motion was normal (apart from the early systolic septal notch) in 34 patients (53%) and abnormal in 30 patients (47%). Rest septal thickening was normal in 32 patients (50%) and abnormal in 32 patients (50%). All seven patients with a QRS duration ≥ 160 ms and an abnormal QRS axis had abnormal rest septal motion and thickening. Inter-observer agreement for ischaemia was 88%. In all but one patient disagreement was in the septum. For the anterior and posterior circulation, respectively, sensitivity was 60% (9/15) and 67% (8/12), specificity was 94% (46/49) and 98% (51/52), and accuracy was 86% (55/64) and 92% (59/64). Sensitivity for the anterior circulation tended to be better in patients with normal rest septal thickening (83% vs 44%). Conclusions: Dobutamine-atropine stress echocardiography has excellent diagnostic specificity in left bundle branch block patients with suspected coronary artery disease. In patients with abnormal rest septal thickening, however, dobutamine-atropine stress echocardiography may lack good sensitivity for detection of coronary artery disease in the anterior circulation. Left bundle branch block patients who potentially most benefit from dobutamine-atropine stress echocardiography may initially be selected by their resting electrocardiogram. (C) 2000 The European Society of Cardiology.

AB - Background: Patients with left bundle branch block exhibit abnormal septal motion which may limit the interpretation of stress echocardiograms. This study sought to assess the diagnostic value of dobutamine-atropine stress echocardiography in left bundle branch block patients. Methods and Results: Sixty-four left bundle branch block patients (mean age 59 years, 24 men) with suspected coronary artery disease underwent dobutamine-atropine stress echocardiography and coronary arteriography. Myocardial ischaemia was defined as new or worsening wall thickening abnormalities. Coronary artery disease was quantitatively defined as a diameter stenosis ≥50% in a major epicardial artery. Rest septal motion was normal (apart from the early systolic septal notch) in 34 patients (53%) and abnormal in 30 patients (47%). Rest septal thickening was normal in 32 patients (50%) and abnormal in 32 patients (50%). All seven patients with a QRS duration ≥ 160 ms and an abnormal QRS axis had abnormal rest septal motion and thickening. Inter-observer agreement for ischaemia was 88%. In all but one patient disagreement was in the septum. For the anterior and posterior circulation, respectively, sensitivity was 60% (9/15) and 67% (8/12), specificity was 94% (46/49) and 98% (51/52), and accuracy was 86% (55/64) and 92% (59/64). Sensitivity for the anterior circulation tended to be better in patients with normal rest septal thickening (83% vs 44%). Conclusions: Dobutamine-atropine stress echocardiography has excellent diagnostic specificity in left bundle branch block patients with suspected coronary artery disease. In patients with abnormal rest septal thickening, however, dobutamine-atropine stress echocardiography may lack good sensitivity for detection of coronary artery disease in the anterior circulation. Left bundle branch block patients who potentially most benefit from dobutamine-atropine stress echocardiography may initially be selected by their resting electrocardiogram. (C) 2000 The European Society of Cardiology.

KW - Coronary artery disease

KW - Dobutamine

KW - Left bundle branch block

KW - Stress echocardigraphy

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