Assessment of ischemia by using dobutamine stress echocardiography test in patients with isolated ST depression in inferior leads demonstrated during channel treadmill exercise electrocardiography test

Karakurt, Ahmet; Kaya, Yüksel; Güvenç, Tolga Sinan; Akbulut, Mehmet

Assessment of ischemia by using dobutamine stress echocardiography test in patients with isolated ST depression in inferior leads demonstrated during channel treadmill exercise electrocardiography test [Kafkas J Med Sci]

Kafkas J Med Sci. 2013; 3(1): 8-14 | DOI: 10.5505/kjms.2013.61687

Assessment of ischemia by using dobutamine stress echocardiography test in patients with isolated ST depression in inferior leads demonstrated during channel treadmill exercise electrocardiography test

Ahmet Karakurt¹, Yüksel Kaya¹, Tolga Sinan Güvenç¹, Mehmet Akbulut²
¹Department Of Cardiology, Kafkas University School Of Medicine, Kars, Turkey
²Department Of Cardiology, Fırat University School Of Medicine, Elazığ, Turkey

AIM
We aimed to evaluate the diagnostic sensitivity, specificity, positive and negative predictive value of dobutamine stress echocardiography test (DSET) in the diagnosis of cardiac ischemia in patients with isolated inferior ST segment depressions in treadmill exercise stress test (TMET).
METHODS
Seventy male patients with horizontal or down sloping of ≥1 mm ST segment depressions, 80 msc after J point in inferior leads during TMET were included in the study. DSET was applied to all patients until at least an 85% of age specific maximal heart rate was reached. A selective coronary ventriculographic examination as a gold standard to evaluate the coronary circulation was performed within 15±5 days of the DSET.
RESULTS
The mean age of the patients was 52±9 years. Vascular stenosis (≥ 50% of a vessel) was demonstrated in the angiographic examination of 28 patients. DSET was positive in 23 and negative in 5 of these cases. DSET positive patients consist of 16 single vessel and 7 two vessel diseases. Coronary angiography examination was normal in 42 of the patients (without stenosis or stenosis of <50%). DSET was negative in 39 of these patients. However, in 3 of patients without vascular stenosis (<50%) DSET was positive. The sensitivity, specificity, positive and negative predictive value of DSET in the diagnosis of inferior cardiac ischemia were 82%, 93%, 88% and 93%, respectively.
CONCLUSION
DSET has a high diagnostic value and should be performed routinely in patients with isolated inferior ST segment depression in TMET.

Keywords: Coronary artery disease, diagnostic tests, dobutamine stress test, interventional tests, Treadmill test

Treadmill egzersiz elektrokardiyografi testinde izole inferior bölge ST çökmeleri saptanan hastalarda dobutamin stres ekokardiyografi testi ile iskeminin değerlendirilmesi

Ahmet Karakurt¹, Yüksel Kaya¹, Tolga Sinan Güvenç¹, Mehmet Akbulut²
¹Kafkas Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Kars
²Fırat Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Elazığ

AMAÇ
Treadmill egzersiz stres testinde (TMET) izole inferior ST segment depresyonu olan hastalarda, koroner iskemiyi tanımada dobutamin stres ekokardiyografi testinin (DSET) uygunluğu ile duyarlılık, özgüllük, pozitif ve negatif öngörü değerlerini araștırmayı amacladık.
YÖNTEM
Çalıșmaya, TMET’de inferior bölgede, ST segmentinin J noktasından 80 ms sonra ≥1 mm down sloping veya horizontal çökmeleri olan, 70 erkek hasta alındı. Bütün hastalara yaşa özgü maksimal kalp hızının en az %85’ine ulaşana kadar DSET uygulandı. DSET sonrası 15±5 gün içinde, koroner dolaşımı değerlendirmek için altın standart test olarak selektif koroner anjiyografi ve ventrikulografi yapıldı.
BULGULAR
Hastaların ortalama yaşları 52±9’du. Koroner anjiyografide 28 hastada vasküler stenoz ( bir damarda ≥ %50) belirlendi. DSET bunların 23’ünde pozitif ve 5’inde negatifti. DSET pozitif hastalar 16 tek damar ve 7 iki damar hastalığından oluşuyordu. Koroner anjiyografi 42 hastada normaldi (stenoz yoktu ya da %50’den azdı). Bu hastaların 39’unda DSET negatifti. Ancak, vasküler stenozu olmayan (<%50) hastada DSET pozitifti. İnferior kardiyak iskemiyi tanımada DSET’in duyarlılığı, özgüllüğü, pozitif ve negatif öngörü değerleri sırasıyla %82, %93, %88 ve %93’tu.
SONUÇ
TMET’de izole inferior segment ST çökmeleri saptanan hastalarda DSET kalp iskemisini saptamada yüksek tanısal değere sahiptir ve rutin olarak kullanılmalıdır.

Anahtar Kelimeler: Koroner arter hastalığı, tanısal testler, dobutamin stres testi, girişimsel testler, Treadmill testi

Ahmet Karakurt, Yüksel Kaya, Tolga Sinan Güvenç, Mehmet Akbulut. Assessment of ischemia by using dobutamine stress echocardiography test in patients with isolated ST depression in inferior leads demonstrated during channel treadmill exercise electrocardiography test. Kafkas J Med Sci. 2013; 3(1): 8-14

Corresponding Author: Ahmet Karakurt, Türkiye

TOOLS