Assessment of the Coronary Artery Disease and Systolic Dysfunction in Hypertensive Patients with the Dobutamine-Atropine Stress Echocardiography: Effect of the Left Ventricular Hypertrophy

This study was performed to evaluate whether left ventricular hypertrophy (LVH) can influence the diagnostic accuracy of coronary artery disease (CAD) using the dobutamine stress echocardiography (DSE) in hypertensive patients. In addition to the detection of CAD, the relationship between systolic dysfunction and the quantitation wall motion scoring system of DSE was studied also. DSE was performed in 101 patients. There were 45 (45%) patients with a history of acute myocardial infarction. Twenty-eight patients (28%) had electrocardiographic LVH and 59 patients (58%) had echocardiographic LVH. A total of 74 patients (73%) had angiographically documented CAD defined as > or = 50% diameter stenosis. For the 56 patients without history of myocardial infarction, the diagnostic sensitivity, specificity, and accuracy in detecting CAD were not influenced by LVH defined by either electrocardiography or echocardiography. For the total patients, the diagnostic sensitivity, specificity, and accuracy in detecting multivessel disease were also not influenced by LVH defined by either method. The resting global wall motion score was correlated well with the left ventricular ejection fraction in patients with and without LVH (r = -0.70, p < 0.001 vs. r = -0.70, p < 0.001). When using the resting wall motion score of 24 as a cutoff value, the diagnostic sensitivity, specificity, and accuracy of systolic dysfunction (defined by left ventricular ejection fraction <40%) were 79, 86 and 85%, respectively. In conclusion, the diagnostic accuracy of CAD using the DSE was not affected by LVH in hypertensive patients. In addition to detection of coronary artery disease, the resting wall motion score of DSE was able to detect systolic dysfunction in patients with and without LVH.