Feasibility, safety and tolerability of accelerated dobutamine stress echocardiography

Abstract

A continuous infusion of a single high dose of dobutamine has been, recently, suggested as a simple and effective protocol of stress echocardiography. The present study assesses the feasibility, safety, and tolerability of an accelerated dobutamine stress protocol performed in patients with suspected or known coronary artery disease. Two hundred sixty five consecutive patients underwent accelerated dobutamine stress echocardiography: the dobutamine was administered at a constant dose of 50 μg/kg/min for up to 10 minutes. The mean weight-adjusted cumulative dose of dobutamine used was 330 ± 105.24 μg/kg. Total duration of dobutamine infusion was 6.6 ± 2.1 min. Heart rate rose from 69.9 ± 12.1 to 123.1 ± 22.1 beats/min at peak with a concomitant change in systolic blood pressure (127.6 ± 18.1 vs. 167.6 ± 45.0 mmHg). Dobutamine administration produced a rapid increase in heart rate (9.4 ± 5.9 beats/min2). The side effects were similar to those described with the standard protocol; the most common were frequent premature ventricular complexes (21.5%), frequent premature atrial complexes (1.5%) and non sustained ventricular tachycardia (1.5%); among non cardiac symptoms the most frequent were nausea (3.4%), headache (1.1%) and symptomatic hypotension (1.1%). No major side effects were observed during the test. Our data demonstrate that a continous infusion of a single high dose of dobutamine is a safe and well tolerated method of performing stress echocardiography in patients with suspected or known coronary artery disease. This new protocol requires the administration of lower cumulative dobutamine dose than standard protocol and results in a significant reduction in test time.

Intraparenchymal haemorrhage and uncal herniation resulting from dobutamine stress echocardiography

“…These complications are not more frequent with accelerated dobutamine infusions 9 10. Unpredictable variability of the pharmacological response to dobutamine is a potential problem.…”

Safety of low-dose dobutamine stress test in coronary slow flow phenomenon

“…There were no incidents of fatal arrhythmias, MI, or syncope. In a study by Minardi et al, dobutamine was administered directly at a constant dose of 50 g/kg/min for 10 min [15]. The incidents of common arrhythmias (e.g., PVCs and PACs), nausea, and dizziness were not obviously increased, compared with the standard infusion protocol.…”

Échographie de stress

“…Aux limites initiales qui portaient essentiellement sur la qualité de l'image, en grande partie corrigée par l'avènement de l'imagerie d'harmonique et l'utilisation du contraste intracavitaire (16), se sont substituées des limites liées soit au type de protocole (17), soit aux modalités (18) et aux indications de l'examen, soit encore à l'interprétation des résultats en fonction de la technique de réfé-rence utilisée (19). L'angiographie coronaire reste la méthode de référence, pour ce qui concerne la défi nition morphologique du degré de signifi cativité d'une sté-nose coronaire mais tant la scintigraphie que l'échographie de stress a l'ambition de documenter l'ischémie, son territoire et donc l'artère responsable de celle-ci.…”