Dobutamine Stress Test: its role in the diagnosis and functional evaluation of coronary artery disease

Dobutamine stress testing is increasingly used for the diagnosis and functional evaluation of coronary artery disease. High dose dobutamine in conjunction with echocardiography or myocardial perfusion scintigraphy was shown to have a good accuracy for the diagnosis and localization of coronary artery disease. Low-dose dobutamine echocardiography is of potential value in the identification of myocardial viability and the prediction of functional improvement of dyssynergic myocardium spontaneously or after revascularization. However, the clinical utility and limitations of dobutamine stress testing in the diagnosis of myocardial viability and ischemia in some clinical settings have not been investigated. The role of dobutamine stress echocardiography and myocardial perfusion scintigraphy in the diagnosis of peri-infarction ischemia has not been established. The influence of fixed wall motion and perfusion abnormalities on the occurrence of ischemic response in peri-infarction area in patients with infarct-related artery stenosis was not studied. Additionally, it is not known if observation of various changes in contractility from low to high-dose dobutamine may be provide data regarding myocardial viability and ischemia additional to those obtained only at low or high dose.