Improved Detection of Inferobasal Ischemia During Dobutamine Echocardiography With

Objectives: The purpose of this study was quantitative evaluation of the inferobasal segment during dobutamine stress echocardiography using Doppler tissue imaging (DTI). Background: Overdiagnosis of myocardial ischemia during dobutamine echocardiography is a common problem. DTI may permit more accurate quantitative diagnosis of ischemia. Methods: A total of 50 patients with normal contraction of the inferobasal segment at rest were referred for dobutamine stress echocardiography. All underwent coronary angiography. Systolic and diastolic myocardial velocities were measured from apical 2-chamber view at rest and at the peak of dobutamine infusion. Results: Stenosis of the right coronary artery > 70% was detected in 11 patients. Conventional stress echocardiography was falsely positive in 10.3% and falsely negative in 27.3%. When DTI was combined with conventional stress echocardiography, sensitivity and specificity was 81.8% and 97.4%, respectively. Conclusion: DTI may enhance the diagnosis of inferior ischemia during dobutamine echocardiography and can be added to conventional imaging in the treatment of these patients. (J Am Soc Echocardiogr 2003;16:403-8.) Wall-motion analysis of the inferobasal segment of the left ventricle is a common problem during dobutamine echocardiography and may be a cause for unnecessary coronary angiography. Even resting imaging of the inferobasal segment often demonstrates abnormal motion as a result of close proximity of the mitral valve and atrioventricular grove. During dobutamine infusion this impairment may become more prominent and can be incorrectly interpreted as ischemia. Overdiagnosis of ischemia has usually occurred in patients with intermediate