Usefulness of Dobutamine Stress Echocardiography for Detecting Restenosis after Coronary Artery Stenting

Kim, Hyun Chul; Chae, Jei Keon; Moon, Sung Ki; Kim, Won Ho; Ko, Jae Ki

Abstract

BACKGROUND AND OBJECTIVES: A noninvasive test with a high predictive value for detecting restenosis is needed to reduce the need for unnecessary coronary angiography. Recently, dobutamine stress echocardiography(DSE) has been shown to be highly sensitive, specific and accurate for the detection of coronary artery disease. No prior study, however, has evaluated its ability to detect restenosis after intracoronary stenting. The aim of this study was to determine the feasibility of DSE for detecting restenosis after intracoronary stenting.
METHODS
To determine the feasibility of DSE for detecting restenosis after intracoronary stenting, the results of follow-up coronary angiography and DSE and treadmill exercise test(TMET) were examined in 36 patients(age, 61+/-6 yeas; 22 men) at least 4 months after angiographically successful intracoronary stenting. The DSE and TMET were performed at day 1. Dobutamine was infused with starting at a dose of 10 microgram/kg/min for 3 minutes, and increasing by 10microgram/kg/min every 3 minutes to a maximum of 40microgram/kg/min. In patients not achieving 85% of their age-predicted maximal heart rate, atropine (0.25mg intravenously, repeated up to maximum of 1mg if necessary) was added while the dobutamine infusion was continued. Positive findings for restenosis were defined as new or worsened wall motion abnormality at a previously dilated vascular territories. The coronary angiography was performed at day 2. Restenosis was defined as > or =50% lumen narrowing, determined by quantitative coronary angiography.
RESULTS
Restenosis was angiographically demonstrated in 14 lesions(34.1%) of 41 lesions. The sensitivity and specificity of DSE for detecting restenosis was 50%(7/14) and 96.2%(26/27), and positive predictive value was 87.5%(7/8), negative predictive value was 78.8%(26/33), respectively. When restenosis was defined as > or =60% lumen narrowing, the sensitivity and specificity of DSE for detecting restenosis was 66.7%(6/9) and 96.9%(31/32), respectively. The target lesion revascularization rate(TLR) was 17%(7/41). The sensitivity of DSE for determining TLR was 85.7% (6/7) and specificity was 97.0%(33/34).
CONCLUSION
It is concluded that DSE has a moderate sensitivity and high specificity for detecting restenosis after intracoronary stenting. DSE may be a useful diagnostic modality for determining target lesion revascularization of restenotic lesion but further studies are needed.