Dobutamine Stress Echocardiography - Need for a Better Gold Standard?

INTRODUCTION: Dobutamine stress echocardiography (DSE) has come a long way as establishing itself as a feasible, safe, effective, relatively cheaper non-invasive technique to detect population suffering from coronary artery disease (CAD) and following up patients post revascuralization. Besides these DSE is commonly used to diagnose low gradient, low flow true severe aortic stenosis (AS); differentiating it from pseudo- AS and to follow up patients with dilated cardiomyopathy (DCMP). Various non-invasive techniques have different sensitivity and specificity to accurately judge a viable myocardium and to accurately detect the improvement in regional wall motion abnormality (RWMA) post-revascularization, leading to an overall increase in left ventricular ejection fraction (LVEF). The comparison of various modalities, role of DSE in intermediate coronary lesions (75%) and other important uses and controversies surrounding DSE are discussed; suggesting the incremental value of DSE as a indispensable and versatile a diagnostic technique.