Stress Echocardiography. Part II. Dobutamine Stress Echocardiography: Techniques, Implementation, Clinical Applications, and Correlations

To describe the rationale, methods, and clinical applications for dobutamine stress echocardiography. We review our experience with the first 1,000 Mayo Clinic patients who underwent this procedure and discuss studies from the literature that have assessed the accuracy of dobutamine stress echocardiography in determining the presence and extent of coronary artery disease. The Mayo protocol for dobutamine stress echocardiography is presented, and the indications for use of this test and comparisons of sensitivity and specificity with other tests are summarized. Although exercise stress testing is the usual noninvasive method for the detection and assessment of coronary artery disease, a substantial number of patients are unable to perform adequate exercise because of physical limitations. In these patients, dobutamine stress echocardiography has emerged as a feasible, safe, and accurate method for the evaluation of coronary artery disease. The test has been proved to be valuable in the noninvasive diagnosis of coronary artery disease and to have an accuracy comparable to that of tomographic perfusion imaging. Other indications for dobutamine stress echocardiog raphy include risk stratification before noncardiac surgical procedures, risk stratification after myocardial infarction, and identification of viable myocardium in patients with left ventricular dysfunction. Dobutamine stress echocardiography is an accurate, safe, cost-effective, and portable procedure for the noninvasive diagnosis of coronary artery disease and for the preoperative assessment of patients with such disease, especially those who are unable to perform adequate exercise tests.