ST-segment elevation during Dobutamine stress-ECG: Echocardiographic and angiographic correlates

Masoor Kamalesh, Krishnaswamy Chandrasekaran, Eliot Schechter, Chittur Sivaram, Udho Thadani

Research output: Contribution to journalArticle

Abstract

Purpose: Prevalence of abnormal ST-segment elevation during exercise stress, when the baseline ECG does not show diagnostic Q waves, is quoted to be <2% and its significance is well studied. Similar data during Dobutamine stress is scant. Method: We prospectively studied the prevalence of ST segment elevation among 105 consecutive male patients referred for Dobutamine stress-imaging study at our VA Medical Center between November 94 and April 95. Six patients (5 without and 1 with Q waves on baseline ECG) developed >0.5mm ST↑ during Dobutamine stress (range 0.5-3.0mm; 3 patients had >1mm). Results: ST segment elevation developed in inferior leads in 5 and in inferolateral leads in the remaining patient. Resting echocardiogram was normal in 4 and showed posterior and septal hypokinesis in 2 patients. Akinesis or worsening of hypokinesis developed in inferior or inferoposterior segments during Dobutamine infusion in all 6 patients. Four of the six patients had significant stenosis of the proximal right coronary artery or PDA, distal to the graft site, while one had 25% PDA lesion and the patient with Q wave had occluded graft to the PDA. Two patients who also had severe LAD disease (70% and 90%) did not develop ST elevation in septal leads. Conclusion and clinical implications: 1) The prevalence of ST segment elevation during Dobutamine stress was 5.2%. 2) Similar to exercise testing, ST segment elevation on Dobutamine stress indicates localizing transmural ischemia when the baseline ECG has no diagnostic Q waves. 3) ST segment elevation was only seen in inferior leads and correlated with angiographic RCA lesions.

Original languageEnglish (US)
Pages (from-to)121S
JournalCHEST
Volume110
Issue number4 SUPPL.
StatePublished - Oct 1 1996
Externally publishedYes

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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    Kamalesh, M., Chandrasekaran, K., Schechter, E., Sivaram, C., & Thadani, U. (1996). ST-segment elevation during Dobutamine stress-ECG: Echocardiographic and angiographic correlates. CHEST, 110(4 SUPPL.), 121S.