PNEUMATIC LOWER EXTREMITY COMPRESSION DURING DOBUTAMINE STRESS ECHOCARDIOGRAPHY: WILL IT INCREASE THE SENSITIVITY FOR DETECTION OF CORONARY ARTERY DISEASE?

Abstract

T he diagnosis of coronary artery disease was possible only through cardiac catheterization and invasive coronary angiography. To avoid the risks of an invasive procedure, stress testing is often employed for an initial assessment of patients with suspected coronary artery disease, serving as a gatekeeper for cardiac catheterization (Armin, 2012). Stress echocardiography was introduced in 1979 and has developed into a versatile technique for identifying patients with CAD and determining prognosis. High temporal and spatial resolution of ultrasound (2–3mm at diagnostic frequencies) along with its relatively low cost and the rapidity with which the test can be performed at bedside are responsible for its widespread use and phenomenal growth (Cheitlin et al., 2003). The concept of therapeutic pneumatic compression of lower part of body was introduced to clinical practice as early as 1903 and its application has been investigated in aerospace and emergency medicine (Crile, 1903). Pneumatic compression on lower extremites leads to increase in systemic vascular resistance, which may affect left ventricular afterload (Dae-Won DW Sohn et al., 2008). But Systemic vascular resistance concerns an unreliable index of left ventricular afterload (Lang et al., 1986). The aim of our study was to assess whether pneumatic lower extremity compression during dobutamine stress echocardiography will increase the sensitivity of the test for detection of coronary artery disease compared to the regular dobutamine stress echocardiography. This study included seventy patients had chest pain with high or intermediate pretest probability of coronary artery disease (CAD), who were referred to cardiology department in Ain shams university hospitals for assessment of coronary artery disease using high dose dobutamine stress echocardiography followed by coronary angiography.