False Positive Dobutamine Stress Echocardiography Induced by Esmolol

Dear Editor, Dobutamine stress echocardiography is one of the several noninvasive methods for detection of coronary artery disease (1). New regional wall motion abnormalities have been reported in dobutamine stress echocardiograpghy after intravenous beta blocker administration (2, 3) Thus, this method has been recommended for increasing the test sensitivity (4). The sensitivity, specificity, accuracy, and positive and negative predictive values of dobutamin stress echocardiography without beta blocker have been reported to be 84%, 92%, 87%, 95%, and 77%, respectively. Using beta blocker, on the other hand, these measures have been reported as 92%, 89%, 91%, 94%, and 87%, respectively (3). In theory, beta blocker induced false positive dobutamine stress echocardiography can occur (5). In this study, a 49 year old woman with the history of abnormal uterine bleeding was candidate for abdominal hysterectomy. The patient complained about atypical chest pain without any defined coronary artery disease risk factors, and was referred for dobutamine stress echocardiography evaluation for preoperative risk stratification. In physical examinations, the patient's heart and lung had unremarkable findings and other cardiovascular examinations were normal. The vital signs before dobutamine stress echocardiography were heart rate = 88 bpm, blood pressure = 135 / 80 mmHg, and respiratory rate = 15. Besides, electrocardiography showed normal sinus rhythm with no ST-T changes. Additionally, resting echocardiography showed normal Left Ventricular Ejection Fraction (LVEF) (LVEF = 55%) with no regional wall motion abnormalities, mild LV diastolic dysfunction, and no significant valvular diseases. Dobutamine doses were increased step by step to 40 mic / Kg / min and the heart rate increased to 145 bpm (90% maximal predicted heart rate), blood pressure increased to 140 / 80 mmHg with no regional wall motion abnormalities, and LVEF increased to 65%. Then, Esmolol 0.5 mg / Kg was administrated in one minute (6). Thereafter, the heart rate decreased to 77 bpm, blood pressure decreased to 130 / 80 mmHg, inferior and inferoseptal walls appeared to be hypokinetic, and LVEF decreased to 45-50%. It should be mentioned that the patient was asymptomatic during the procedure without any ST segment changes. According to dobutamine stress echocardiography results, the patient was referred for selective coronary angiography. Hosseinsabet A et al. In selective coronary angiography, the left coronary system was normal. The right coronary artery was also normal; however, when the catheter was engaged in the right coronary artery and injection was done, localized dissection of ascending aorta appeared …