AIM To evaluate the angiographic, myocardial perfusion, and wall motion abnormalities in patients with severe compared with mild worsening of regional function during dobutamine stress echocardiography (DSE) for evaluation of myocardial ischaemia.

RESULTS Severe worsening of regional function (an increase in wall motion score of two grades or more in ⩾ 1 segment) was detected in 37 patients, while 110 patients had mild worsening (an increase in wall motion score of no more than one grade in ⩾ 1 segment). Patients with severe worsening of regional function had more stenotic coronary arteries (2.31 (0.8) v1.97 (0.8) (mean (SD)) (p <0.05), a higher prevalence of left anterior descending coronary artery disease (95%v 73%) (p < 0.05), a higher resting wall motion score index (1.71 (0.42) v 1.51 (0.40) (p = 0.01), and more stress perfusion defects (3.8 (1.5)v 2.8 (1.5) (p < 0.001) compared with patients with mild worsening. Multivariate analysis identified the number of stress perfusion defects (p < 0.005, χ² = 8.8) and the number of ischaemic segments on echocardiography (p < 0.05, χ² = 4.3) as independent variables associated with severe worsening of regional function.

CONCLUSIONS The grade of worsening of regional function during DSE predicts the underlying extent of myocardial perfusion abnormalities. The occurrence of severe worsening of regional function is associated with variables known to predict worse prognosis in patients with coronary artery disease.