Stress testing with closed-loop arbutamine as an alternative to exercise

Dennis, C; Pool, Peter E.; Perrins, Edward J.; Mohiuddin, Syed M.; Sklar, Joel; Kostuk, William J.; Müller, D.; Starling, Mark R.

doi:10.1016/0735-1097(95)00297-9

“…The safety profile for arbutamine as described in these studies (9,10,18) is similar to that reported for dobutamine (28,34,36) and is consistent with the use of a catecholamine as a pharmacological stress agent. The most frequent adverse events reported with arbutamine were tremor (8-23%), flushing (1O-15%), headache (8-12%), arrhythmias ( 6 7 % ) , dizziness (1-8%) and hypotension (47%).…”

Section: Clinical Experiencesupporting

confidence: 80%

“…The most frequent arrhythmias reported were premature ventricular complexes (3%) and potentially significant arrhythmias, such as non-sustained ventricular tachycardia, supraventricular tachycardia, and atrial fibrillation, were rare (<2.0%). Two patients in the ECG study experienced ventricular fibrillation (10). In one case, the arrhythmia occurred after the investigator restarted the arbutamine infusion following its termination by the GenESA Device because of a decrease in heart rate (the heart rate saturation phenomenon described earlier).…”

Section: Clinical Experiencementioning

confidence: 97%

Arbutamine: A Novel Catecholamine for Pharmacologie Diagnosis of Coronary Disease

Young

¹

,

Valcke

²

,

Mullane

³

et al. 1995

Cardiovascular Drug Reviews

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“…Arbutamine is a recently developed sympathomimetic which has been shown to be a safe and effective method of detecting coronary artery disease [7][8][9][10][11]. The present study compared the physiological responses occurring during arbutamine and conventional exercise stress testing.…”

Section: Discussionmentioning

confidence: 99%

Comparative physiological study of arbutamine with exercise in humans

LOVELL¹,

MAGUIRE²,

TURTLE³

et al. 2000

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Pharmacological stress testing may be used in the diagnosis of coronary artery disease when there are contra-indications to the use of conventional exercise protocols. The responses to such testing using arbutamine and to conventional treadmill exercise were compared in eight patients. Respiratory gas analysis and cardiovascular observations were performed during both tests. For an equivalent increment in heart rate, both protocols increased systolic blood pressure and serum lactate. Minute ventilation and oxygen consumption also rose during both protocols, but much more so with exercise. The end-tidal partial pressure of CO(2) [35.1 (S.D. 3. 1) to 30.8 (6.6) mmHg] and the dead space/tidal volume ratio (V(D)/V(T)) [0.37 (0.09) to 0.33 (0.08)] fell significantly during arbutamine infusion, but the respiratory exchange ratio did not change during either protocol. Oxygen pulse, a marker of stroke volume, did not change significantly after arbutamine, but rose markedly after exercise [arbutamine, 3.9 (1.1) to 3.37 (0.7) ml. min(-1).beat(-1); exercise, 4.7 (1.4) to 16.1 (4.6) ml.min(-1). beat(-1) (P<0.0001 compared with baseline); difference between peak responses: P<0.0001]. We conclude that arbutamine simulates some of the physiological responses to exercise, although a number of these responses are less marked than during conventional exercise, in particular cardiac output (oxygen pulse). An increase in ventilation is produced, possibly due to direct stimulation of arterial chemoreceptors. These data suggest that the main action of arbutamine is to increase central drive rather than to establish peripheral demand.

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“…In summary, arbutamine produces important physiological and metabolic effects which have been proven to be of value in the diagnosis of coronary artery disease [10,11], especially when there are contra-indications to conventional treadmill or bicycle exercise protocols. Arbutamine infusion is associated with an increase in the following parameters : heart rate, systolic blood pressure,…”

Section: Discussionmentioning

confidence: 99%

“…It has both inotropic and chronotropic effects, simulating some of the effects of exercise, including increases in cardiac contractility, systolic blood pressure and heart rate [8]. A computercontrolled ' closed-loop ' system is used to deliver the arbutamine, based upon the heart rate responses [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Comparative physiological study of arbutamine with exercise in humans

Lovell

¹

,

Maguire

²

,

Turtle

³

et al. 2000

View full text Add to dashboard Cite

Pharmacological stress testing may be used in the diagnosis of coronary artery disease when there are contra-indications to the use of conventional exercise protocols. The responses to such testing using arbutamine and to conventional treadmill exercise were compared in eight patients. Respiratory gas analysis and cardiovascular observations were performed during both tests. For an equivalent increment in heart rate, both protocols increased systolic blood pressure and serum lactate. Minute ventilation and oxygen consumption also rose during both protocols, but much more so with exercise. The end-tidal partial pressure of CO(2) [35.1 (S.D. 3. 1) to 30.8 (6.6) mmHg] and the dead space/tidal volume ratio (V(D)/V(T)) [0.37 (0.09) to 0.33 (0.08)] fell significantly during arbutamine infusion, but the respiratory exchange ratio did not change during either protocol. Oxygen pulse, a marker of stroke volume, did not change significantly after arbutamine, but rose markedly after exercise [arbutamine, 3.9 (1.1) to 3.37 (0.7) ml. min(-1).beat(-1); exercise, 4.7 (1.4) to 16.1 (4.6) ml.min(-1). beat(-1) (P<0.0001 compared with baseline); difference between peak responses: P<0.0001]. We conclude that arbutamine simulates some of the physiological responses to exercise, although a number of these responses are less marked than during conventional exercise, in particular cardiac output (oxygen pulse). An increase in ventilation is produced, possibly due to direct stimulation of arterial chemoreceptors. These data suggest that the main action of arbutamine is to increase central drive rather than to establish peripheral demand.

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Stress testing with closed-loop arbutamine as an alternative to exercise

Cited by 36 publications

References 22 publications

Arbutamine: A Novel Catecholamine for Pharmacologie Diagnosis of Coronary Disease

Arbutamine: A Novel Catecholamine for Pharmacologie Diagnosis of Coronary Disease

Comparative physiological study of arbutamine with exercise in humans

Comparative physiological study of arbutamine with exercise in humans

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