Stress echo vs dobutamine stress echo

I am 64, 165# and generally in good health. I am on statins (Advicor 1000/20 plus 1000 mg of time-released niacin - Niaspan)as well as low-dose aspirin. My last lipid panel (Aug 2006) showed LDL 56 and HDL 83; VAP results were HDL-2 30, HDL-3 53, VLDL-3 7, Sum Total LDL-C 56 and Real-LDL size pattern was in the A/B range, closer to pattern A. I recently had to change doctors and because I have had a couple of heart scans (the first in 2001 and the last in 2005)that show calcification in the LAD (Agatston score 105.06) and RCA (Agatston score 179.21), my new doctor recommended a dobutamine stress echo test. I've never had a stress test and what I read about the dobutamine stress test is that it is used when the patient cannot do the exercise stress test. I am fit and exercise strenuously and regularly (4-5 times a week) without adverse affects.

Is there some advantage to the dobutamine test that I am not seeing in the literature available?

Am I better off to take the exercise stress echo test?

I have also read that the 3D echo is much preferable to the 2D -please comment.

[CCF-M.D.-MJM]

Hello,

Exercise stress tests are preferred to domutamine echo's because it gives additional information about functional capacity and a real look at your EKG on real-life condition.  If you can exercise, exercise echo is the right test.

If you aren't having symptoms, the other question is do you even need  a stress test.  There is only a proven benefit to cardiac cath with stenting or bypass in the setting of symptomatic chest pain or equivalent.  Unless there is another pressing issue that you didn't mention, I am not sure that you need a stress test at this time.

3D echo is more of research tool now.  2D echo is just fine for the procedure.

I hope this answers your questions.  good luck and thanks for posting.

[chrisr]

I think that Advicor has Niaspan so why the additional 1000mg Niaspan? Was this extra needed to get to your low LDL and rel high HDL? And what about your Triglycerides? Hope you don't mind my probing but I have consitently high TGs, LDL and low HDL (35-40)with a B-pattern LDL but tried Niaspan and could not tolerate it. Did you start the Advicor first? Would certainly like to have a lipid profile in your range.
I did have both Echo stress followed some months later by the Dobutamine but saw very little differences except that the Dob gave me severe flushing and palps effects. I also think that the Echo stress is better once you can tolerate it. I also have some persistent chest discomfort with nausea so may eventually have to do an Angio. Will appreciate your comments on the meds and wish you all the best.