Abstract
Background and objective Dobutamine stress echocardiography (DSE) is a commonly used, radiation-free method for identifying inducible ischemia in patients with chronic coronary syndromes (CCSs). Contemporary European guidelines promote ischemia-guided management and recommend functional imaging in patients with an intermediate-to-high likelihood of obstructive coronary artery disease (CAD); however, real-world data on the therapeutic impact of DSE, particularly in high-risk metabolic populations, remain limited. The objective of this study was to evaluate the correlation between DSE findings and myocardial revascularization in patients with significant CAD. Methods We conducted a retrospective, single-center study in the cardiology department of a Moroccan university hospital. All patients undergoing DSE between November 2024 and November 2025 were screened (n = 133); those with a positive or equivocal DSE who subsequently underwent coronary angiography formed the study cohort (n = 38). Significant CAD was defined as ≥50% left main stenosis or ≥70% stenosis of a major epicardial vessel. We assessed the prevalence of significant CAD, patterns of revascularization (medical therapy, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG)), the relationship between DSE-derived ischemic burden and coronary anatomy, and the performance of the 2024 ESC pretest probability (PTP) categories. Results Significant CAD was present in 30/38 patients (78.9%), and all CAD-positive patients underwent revascularization (25 PCI and five CABG). PCI was used exclusively in single-vessel disease, whereas CABG was preferred in multivessel or left main disease. The mean number of ischemic segments was higher in CAD-positive than in CAD-negative patients (3.64 vs. 1.50; p = 0.0044), and territorial concordance between DSE and angiography was 67.6%. The correlation between the number of ischemic segments and the number of diseased vessels was modest (r = 0.19). The ESC 2024 PTP strata did not discriminate between CAD-positive and CAD-negative patients; notably, most patients with low or very low PTP and significant CAD were diabetic. Conclusions In this real-world Moroccan cohort, DSE demonstrated a high diagnostic and therapeutic yield, with ischemic burden and localization strongly influencing revascularization strategy. These findings underscore the limitations of PTP-based approaches in high-risk metabolic populations and support DSE as a practical gatekeeper to invasive angiography and guideline-based revascularization in CCS.