Dobutamine digital echocardiography for detecting coronary artery disease

Cohen, Jacob; Greene, Trevor O.; Ottenweller, John E.; Binenbaum, Steve Z.; Wilchfort, Samuel D.; Kim, Chung S.

doi:10.1016/0002-9149(91)90457-v

Cited by 215 publications

(72 citation statements)

References 24 publications

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“…The study results are in contrast to the results of Cohen et al (15), which showed a close relation between HR increment and dobutamine infusion rate. However, instead of 10 µg/kg/min, they used a 5 µg/kg/min dobutamine increment every 3 min.…”

Section: Optimal Dobutamine Plasma Concentration For Assessment Of Cocontrasting

confidence: 99%

“…A positive response at low dose or low HR threshold is associated with a complex coronary artery lesion (13 16). A recent development is the introduction of the semiquantitative stress test (14,15). The presence of ischemia is noted as well as the extent (number of segments), the severity at peak stress (hypokinesia vs. dyskinesia), and the stage at which ischemia occurs.…”

Section: Optimal Dobutamine Plasma Concentration For Assessment Of Comentioning

confidence: 99%

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Hemodynamic Changes, Plasma Catecholamine Responses, and Echocardiographically Detected Contractile Reserve During Two Different Dobutamine-Infusion Protocols

Poldermans¹,

Boersma²,

Fioretti³

et al. 1997

Journal of Cardiovascular Pharmacology

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Summary:We studied hemodynamic changes, catecholamine responses, and the occurrence of improved wall thickening by echocardiography during two different dobutamine infusion protocols. Forty three patients were studied by using a stepwise incremental dobutamine dose infusion protocol (10 40 µg/kg/min, 3 min intervals); a subgroup of 11 patients also underwent a continuous dobutamine infusion protocol (10 µg/kg/min for 12 min) in random order. No patient used [beta] blockers. At 3 min intervals, blood pressure, heart rate, and plasma concentrations of dobutamine, epinephrine, and norepinephrine were measured. The echocardiographic improvement of wall thickening was analyzed only in paired protocols by visual assessment in left ventricular regions with normal wall motion at rest. The mean heart rate increased in the continuous and stepwise protocols from 73 to 99 and 74 to 132 beats/min. There was no significant change in blood pressure response between the two protocols. The mean plasma dobutamine concentrations during the continuous and stepwise protocols at 0, 3, 6, 9, and 12 min were 0/0; 31/38; 80/203; 106/448; and 120/692 ng/ml, respectively. In each patient, a response curve was constructed for the plasma dobutamine concentration versus heart rate. The heart rate increment and dobutamine concentration at which wall thickening was detected were similar with both protocols (14 ± 5 vs. 12 ± 7 beats/min) and (80 ± 40 vs. 92 ± 48 ng/ml; mean ± SD). Wall thickening was noted in two of 11 patients between 0 and 3 min and 11 of 11 patients between 3 and 6 min in both protocols. Catecholamine responses during the continuous and stepwise protocols were epinephrine, 23 versus 28/28 versus 36, and norepinephrine 301 versus 323/347 versus 519. Only norepinephrine plasma concentrations increased significantly during the stepwise protocol. A 6 min dobutamine infusion was sufficient during both protocols to reach an adequate plasma dobutamine concentration, which induced a detectable increase of wall thickening in all patients. There is a significant differences between the two protocols with regard to the plasma catecholamine changes, so some of the hemodynamic effects during the stepwise dobutamine infusion protocol may be mediated through release of endogenous catecholamines.

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Section: Optimal Dobutamine Plasma Concentration For Assessment Of Cocontrasting

confidence: 99%

Section: Optimal Dobutamine Plasma Concentration For Assessment Of Comentioning

confidence: 99%

Hemodynamic Changes, Plasma Catecholamine Responses, and Echocardiographically Detected Contractile Reserve During Two Different Dobutamine-Infusion Protocols

Poldermans¹,

Boersma²,

Fioretti³

et al. 1997

Journal of Cardiovascular Pharmacology

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“…11,[17][18][19] Those findings are concordant with our study, suggesting that the ischemic threshold extracted from continuous monitoring of LV function during EE could represent a reliable tool for the evaluation of the severity of coronary stenosis. 20,21 Our data also confirm the diagnostic accuracy of EE for the detection of patients with single-vessel CAD.…”

supporting

confidence: 91%

Stratification of single-vessel coronary stenosis by ischemic threshold at the onset of wall motion abnormality during continuous monitoring of left ventricular function by semisupine exercise echocardiography

Garot¹,

Hoffer²,

Monin³

et al. 2001

Journal of the American Society of Echocardiography

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“…coronary artery stenosis [5][6][7][8][9]. However, high doses of dobutamine are necessary to detect CAD even in patients with critical coronary stenosis.…”

Section: Utility Of Combined Assessment Of Coronary Flow Velocity Andmentioning

confidence: 99%

“…Dobutamine induces an imbalance between myocardial oxygen supply and demand followed by the ischemic cascade. DSE has been established as one of the useful tools for detecting CAD [5][6][7][8][9]. However, in DSE studies, use of high-dose dobutamine with additional injections of atropine impaired the ability to evaluate wall motion, and prolonged testing are limitations.…”

Section: Ischemic Cascadementioning

confidence: 99%

Utility of Combined Assessment of Coronary Flow Velocity and Myocardial Perfusion During Low-dose Dobutamine Stress Echocardiography in the Detection of Left Anterior Coronary Artery Disease

Ohno¹,

Honma²,

Takayama³

et al. 2006

J Echocardiogr

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Background. Ischemia produces a sequence of events beginning with a decline in coronary flow reserve, myocardial perfusion abnormalities, and wall motion abnormalities. We hypothesized that low-dose dobutamine stress, combined with myocardial contrast echocardiography (MCE) and transthoracic Doppler echocardiography (TTDE), could detect myocardial ischemia preceding wall motion abnormalities according to this ischemic cascade.Methods. Ninety-six patients suspected of having stable angina pectoris underwent TTDE, MCE, and semi-quantitative dobutamine stress echocardiography (Semi-DSE). Wall motion was assessed using a scoring system. The contrast agent, Levovist, was injected intravenously to assess the coronary flow velocity (CFV) ratio in the left anterior descending coronary artery (LAD) and myocardial perfusion abnormalities in the LAD territory. The CFV ratio was calculated as the CFV during low-dose dobutamine stress divided by the baseline CFV. Time-intensity data for MCE were fitted for y = A (1 e t ) from which the rate of the intensity rise ( ) was calculated and the ratio was derived at baseline and during stress.Results. Semi-DSE and low-dose dobutamine stress combined with TTDE and MCE were obtained successfully in 85patients. The sensitivity and specificity of Semi-DSE for detecting 75% LAD stenosis were 79% and 93%, respectively. In the LAD territory, Semi-DSE showed 6 false negative and 4 false positive findings. However, failures of the CFV ratio and ratio to increase >1.81 and >1.23 times that at baseline, respectively, indicated the presence of critical LAD stenosis, especially in 3 out of 6 false negative cases.Conclusions. Low-dose dobutamine stress combined with TTDE and MCE is a useful method for detecting critical LAD stenosis during Semi-DSE. This method overcomes the limitations of Semi-DSE. (J Echocardiogr 2006; 4: 69-77)

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Dobutamine digital echocardiography for detecting coronary artery disease

Cited by 215 publications

References 24 publications

Hemodynamic Changes, Plasma Catecholamine Responses, and Echocardiographically Detected Contractile Reserve During Two Different Dobutamine-Infusion Protocols

Hemodynamic Changes, Plasma Catecholamine Responses, and Echocardiographically Detected Contractile Reserve During Two Different Dobutamine-Infusion Protocols

Stratification of single-vessel coronary stenosis by ischemic threshold at the onset of wall motion abnormality during continuous monitoring of left ventricular function by semisupine exercise echocardiography

Utility of Combined Assessment of Coronary Flow Velocity and Myocardial Perfusion During Low-dose Dobutamine Stress Echocardiography in the Detection of Left Anterior Coronary Artery Disease

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