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lüll Assessment of a new non-invasive index of cardiac performance for detection of dobutamine-induced myocardial ischemia Gorenberg M; Marmor AIsr Med Assoc J 2007[Apr]; 9 (4): 286-9BACKGROUND: Electrocardiography has a very low sensitivity in detecting dobutamine-induced myocardial ischemia. OBJECTIVES: To assess the added diagnostic value of a new cardiac performance index (dP/dtejc) measurement, based on brachial artery flow changes, as compared to standard 12-lead ECG, for detecting dobutamine-induced myocardial ischemia, using Tc99m-Sestamibi single-photon emission computed tomography as the gold standard of comparison to assess the presence or absence of ischemia. METHODS: The study group comprised 40 patients undergoing Sestamibi-SPECT/dobutamine stress test. Simultaneous measurements of ECG and brachial artery dP/dtejc were performed at each dobutamine level. In 19 of the 40 patients perfusion defects compatible with ischemia were detected on SPECT. The increase in dP/dtejc during infusion of dobutamine in this group was severely impaired as compared to the non-ischemic group. dP/dtejc outcome was combined with the ECG results, giving an ECG-enhanced value, and compared to ECG alone. RESULTS: The sensitivity improved dramatically from 16% to 79%, positive predictive value increased from 60% to 68% and negative predictive value from 54% to 78%, and specificity decreased from 90% to 67%. CONCLUSIONS: If ECG alone is used for specificity, the combination with dP/dtejc improved the sensitivity of the test and could be a cost-savings alternative to cardiac imaging or perfusion studies to detect myocardial ischemia, especially in patients unable to exercise.|Aged[MESH]|Blood Pressure/*physiology[MESH]|Cardiotonic Agents/administration & dosage/*adverse effects[MESH]|Dobutamine/administration & dosage/*adverse effects[MESH]|Electrocardiography[MESH]|Exercise Test/*adverse effects[MESH]|Female[MESH]|Follow-Up Studies[MESH]|Humans[MESH]|Infusions, Intravenous[MESH]|Male[MESH]|Myocardial Contraction/*physiology[MESH]|Myocardial Ischemia/chemically induced/*diagnostic imaging/physiopathology[MESH]|Radiopharmaceuticals/administration & dosage[MESH]|Reproducibility of Results[MESH]|Sensitivity and Specificity[MESH]|Technetium Tc 99m Sestamibi/administration & dosage[MESH]|Tomography, Emission-Computed, Single-Photon/*methods[MESH] |