Lower limb pneumatic compression during dobutamine stress echocardiography in patients with normal resting wall motion: will it increase diagnostic accuracy?

BACKGROUND

Pneumatic compression of the lower part of the body increases systemic vascular resistance and left ventricular afterload.

AIM: We compared the diagnostic accuracy of dobutamine stress echocardiography (DSE) with pneumatic compression of the lower extremities, vs. standard DSE, for detection of angiographically significant coronary artery disease (CAD) in patients with normal baseline resting wall motion.

METHODS

We enrolled 70 consecutive patients with no resting wall motion abnormalities (WMA), who underwent DSE. DSE was repeated with pneumatic compression of the lower extremities three days after the initial standard DSE. A positive test was defined as the induction of WMA in at least two contiguous non-overlap segments at any stage of dobutamine infusion. Significant coronary stenosis was defined as ≥ 50% obstruction of ≥ 1 sizable artery by coronary angiography.

RESULTS

The mean age of the study cohort was 54.7 ± 9.9 years; 55.7% were females. Thirty-eight (54.3%) patients had significant CAD. The mean test duration was 15.8 ± 5.1 min for standard DSE and 11.7 ± 4.1 min for DSE with pneumatic compression. Analysis of standard DSE revealed sensitivity, specificity, and positive and negative predictive values of 81.6%, 90.6%, 91.2%, and 80.6%, respectively; overall accuracy was 85.7%. Analysis of DSE with pneumatic compression revealed sensitivity, specificity, and positive and negative predictive values of 89.5%, 87.5%, 89.5%, and 87.5%, respectively; overall accuracy was 88.6%.

CONCLUSIONS

In symptomatic patients with suspected CAD referred for evaluation by DSE, who have no resting wall motion abnormalities, pneumatic compression of the lower extremities during DSE improved the sensitivity but slightly reduced the specificity for detection of angiographically significant CAD, compared with standard DSE. Moreover, it reduced the test duration.