764-1 Dobutamine Transesophageal Echo in the Assessment of Coronary Artery Disease: Comparison with Dobutamine Transthoracic Echo in the Same Setting

Dobutamine stress echo (DSE) is a valuable technique in the assessment of coronary artery disease (CAD). However, its role is limited when transthoracic (TTE) images are suboptimal. Transesophageal echo (TEE) may overcome this limitation due to less acustic impedance. To define the value of Dob-TEE in assessing CAD, 60 pts (54 male; 6 female; mean age 59 ± 13 yrs) underwent near-simultaneous Dob-TTE and Dob-TEE in the same setting. Elective coronary angiography was performed within 5 days. HE and TEE were performed at rest, during Dob infusion and 3 min after recovery. Dob was infused in 3-min increments from 5 to 40 mcg/kg/min. Atropine (0.5–1.0 mg) was added in case of insufficient chronotropic response to Dob (85% predicted heart rate). Segments of the LV either from HE orTEE were grouped according to the 3 main coronary artery distributions. DSE was considered abnormal if new or worsening of segmental wall motion abnormalities (SWMA) were noted. Results All segments representing the 3 coronary artery distributions were seen in all pts (100%) by TEE and in 43 pts (72%) by HE. DSE was positive in 46 of 49 pts with significant CAD (≥ 50% stenosis) and it was negative in 8 of 11 pts with normal arteries or non-significant disease (sensitivity 94%, specificity 73%, positive predictive value 94%, negative predictive value 73% and diagnostic accuracy 90%). There was no difference between HE and TEE results in the 43 pts with good quality HE images. The heart rate (145 ± 10 vs 122 ± 16 bpm respectively p l 0.001) and the dose of Dob (38 ± 3 vs 29 ± 6 mcg/kg/min p l 0.001) atwhich SWMA began to occur or worsen from previously abnormal were significantly higher in pts with single-vessel disease than in those with multi-vessel disease. Dob infusion was well tolerated and no serious complications occurred. Conclusions Dab-TEE is a safe and highly accurate alternative to Dob-TTE when precordial 2D images are suboptimal. Early positive DSE response suggests multi-vessel disease.