Background: Several testing options are available to detect asymptomatic coronary artery disease (CAD). Dobutamine stress echocardiography (DSE) has been reported to increase the sensitivity and specificity of stress testing to detect CAD. Most studies concerned patients with known or suspected CAD who have a high pretest probability of disease. We aimed to perform a preliminary evaluation of DSE in atherothrombotic stroke. Methods: Patients with transient ischemic attack or nondisabling ischemic stroke attributable to an atherothrombotic source were prospectively recruited. Patients with a history of angina pectoris or electrocardiographic signs of previous myocardial infarction were excluded. DSE was considered positive when regional reduction or deterioration of myocardial thickening developed in 1 segment. Coronary angiography was performed in patients with positive DSE. Results: Sixty-four patients were recruited. Analysis of DSE was possible in 60 patients. Overall the test provided clinically useful information in 60/64 patients studied (>90%). DSE was positive in 9 patients (15%). Coronary angiography was performed in 8 patients, high-grade focal lesions were found in 3 patients, and 5 patients showed diffuse atheroma. Univariate logistic regression analysis showed that the main factor predictive of a positive DSE was the presence of an aortic arch atheroma (p = 0.003). Multivariate logistic regression analysis showed that two factors had an independent predictive value of positive DSE: aortic arch atheroma (p = 0.007) and dyslipidemia (p = 0.09). Conclusion: DSE may improve prevention of further vascular events in patients with an atherothrombotic source of ischemic stroke. This screening may be of particular benefit to patients with an aortic arch atheroma.

Keywords:
Stroke, Atherothrombosis, Coronary artery disease, asymptomatic, Dobutamine stress echocardiography
1.
Adams RJ, Chimowitz MI, Alpert JS, Awad IA, Cerquiera MD, Fayad P, Taubert KA: Coronary risk evaluation in patients with transient ischemic attack and ischemic stroke. A scientific statement for healthcare professionals from the stroke council and the council on clinical cardiology of the American Heart Association/American Stroke Association. Circulation 2003;108:1278–1290.
2.
Rokey R, Rolak LA, Harati Y, et al: Coronary artery disease in patients with cerebrovascular disease: a prospective study. Ann Neurol 1984;16:50–53.
3.
Di Pasquale G, Andreoli A, Pinelli G, et al: Cerebral ischemia and asymptomatic coronary artery disease: a prospective study of 83 patients. Stroke 1986;17:1098–1101.
4.
Gates P, Peppard R, Kempster P, et al: Clinically unsuspected cardiac disease in patients with cerebral ischemia. Clin Exp Neurol 1987;23:75–80.
5.
Chimowitz MI, Poole RM, Starling MR, Schwaiger M, Gross MD: Frequency and severity of asymptomatic coronary disease in patients with different causes of stroke. Stroke 1997;28:941–945.
6.
Arenillas JF, Candell-Riera J, Romero-Farina G, Molina CA, Chacon P, Aguade-Bruix S, Montaner J, de Leon G, Castell-Conesa J, Alvarez-Sabin J: Silent myocardial ischemia in patients with symptomatic intracranial atherosclerosis: associated factors. Stroke 2005;36:1201–1206.
7.
Smith SC Jr, Amsterdam E, Balady GJ, Bonow RO, Fletcher GF, Froelicher V, Heath G, Limacher MC, Maddahi J, Pryor D, Redberg RF, Roccella E, Ryan T, Smaha L, Wenger NK: Prevention Conference V: beyond secondary prevention: identifying the high-risk patient for primary prevention: tests for silent and inducible ischemia: Writing Group II. Circulation 2000;101:E12–E16.
8.
Senior R, Monaghan M, Becher H, Mayet J, Nihoyannopoulos P: Stress echocardiography for the diagnosis and risk stratification of patients with suspected or known coronary artery disease: a critical appraisal. Supported by the British Society of Echocardiography. Heart 2005;91:427–436.
9.
Biagini E, Elhendy A, Bax JJ, Schrinkel AFL, Poldermans D: The use of stress echocardiography for prognostication in coronary artery disease: an overview. Curr Opin Cardiol 2005;20:386–394.
10.
Barnett HJ, Taylor DW, Eliasziw M, Fox AJ, Ferguson GG, Haynes RB, Rankin RN, Clagett GP, Hachinski VC, Sackett DL, Thorpe KE, Meldrum HE, Spence JD: Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 1998;339:1415–1425.
11.
Adams H, Adams R, Del Zoppo G, Goldstein LB; Stroke Council of the American Heart Association; American Stroke Association: Guidelines for the early management of patients with ischemic stroke: 2005 guidelines update a scientific statement from the Stroke Council of the American Heart Association/American Stroke Association. Stroke 2005;36:916–923.
12.
Seward JB, Khandheria BK, Oh JK, Abel MD, Hughes RW, Edwards MD, Nichols BA, Freeman WK, Tajik AJ: Transesophageal echocardiography: technique, anatomic correlations, implementation and clinical applications. Mayo Clin Proc 1988;63:649–680.
13.
Black IW, Hopkins AP, Lee LC, Walsh WF: Left atrial spontaneous echo contrast: a clinical and echocardiographic analysis. J Am Coll Cardiol 1991;18:398–404.
14.
Amarenco P, Cohen A, Tzourio C, et al: Atherosclerotic disease of the aortic arc and the risk of ischemic stroke. N Engl J Med 1994;331:1474–1479.
15.
Armstrong WF, Pellikka PA, Ryan T, Crouse L, Zoghbi WA: Stress echocardiography: recommendations for performance and interpretation of stress echocardiography. Stress Echocardiography Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. J Am Soc Echocardiogr 1998;11:97–104.
16.
Touze E, Varenne O, Chatellier G, Peyrard S, Rothwell PM, Mas JL: Risk of myocardial infarction and vascular death after transient ischemic attack and ischemic stroke: a systematic review and meta-analysis. Stroke 2005;36:2748–2755.
17.
Detrano R, Gianrossi R, Froelicher V: The diagnostic accuracy of the exercise electrocardiogram: a meta-analysis of 22 years of research. Prog Cardiovasc Dis 1989;32:173–206.
18.
Marwick TH: Current status of non-invasive techniques for the diagnosis of myocardial ischemia. Acta Clin Belg 1992;47:1–5.
19.
Fleischmann KE, Hunink MGM, Kuntz KM, et al: Exercise echocardiography or exercise SPECT imaging? JAMA 1998;280:913–920.
20.
Bremer ML, Monahan KH, Stussy VL, Miller FA Jr, Seward JB, Pellikka PA: Safety of dobutamine stress echocardiography supervised by registered nurse sonographers. J Am Soc Echocardiogr 1998;11:601–605.
21.
Rohani M, Jogestrand T, Ekberg M, van der Linden J, Kallner G, Jussila R, Agewall S: Interrelation between the extent of atherosclerosis in the thoracic aorta, carotid intima-media thickness and the extent of coronary artery disease. Atherosclerosis 2005;179:311–316.
22.
Fazio GP, Redberg RF, Winslow T, Schiller NB: Transesophageal echocardiographically detected atherosclerotic aortic plaque is a marker for coronary artery disease. J Am Coll Cardiol 1993;21:144–150.
© 2006 S. Karger AG, Basel
2006
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.