The dobutamine stress test as an alternative to exercise testing after acute myocardial infarction.

Abstract

SUMMARY Three weeks after myocardial infarction in 50 patients the effect of the infusion of a graded dose of dobutamine was compared with that of symptom limited treadmill exercise testing. The following variables were measured: blood pressure, heart rate, ST segment changes, Doppler aortic blood flow, and cross sectional echocardiographic dimensions. The heart rate and double product increased more -during exercise than during dobutamine infusion, while maximum acceleration in the ascending aorta increased more during dobutamine infusion than during exercise. Significant ST depression was recorded in 22 Patients and methods PATIENTSExercise and dobutamine stress tests were performed three weeks after acute myocardial infarction in fifty patients (mean (SD) age 56 (5), range 35-69). Nine (18%) of the patients were women. The diagnosis of acute myocardial infarction was based on at least two of three criteria: (a) a history of chest pain suggestive of myocardial ischaemia persisting for at least 30 minutes; (b) evolution ofnew pathological Q waves or persistent ST-T wave changes suggestive of non-Q wave infarction; (c) a rise in the concentrations of aspartate transaminase, hydroxybutyrate dehydrogenase, or creatine kinase to at least twice the upper limits of the reference ranges. The resting electrocardiogram showed anterior infarction in 16 patients, inferior in 22, lateral in four, true posterior in two, and non-Q wave infarction in six. Three (6%) patients had a history of a previous myocardial infarction. Patients with bundle branch block or nonischaemic valvar heart disease were excluded.Patients were randomly selected for the study before the exercise test and their written consent was obtained. 521

Dobutamine Stress Echocardiography for Detecting Coronary Artery Disease

“…** p < 0.001 compared to the data on maximal dose of dobutamine infusion. 17 and no significant disease in 13. One-vessel disease was present in 5 patients, two-vessel disease in 5, threevessel disease in 7, and left main coronary artery involve ment in 1.…”

“…Taiwan 10016 (Republic of China) ing in patients with CAD in recent years [15][16][17][18][19][20][21]. Nev ertheless, comparisons between dobutamine stress echo cardiography (DSE) and treadmill exercise test (TXT) were rarely reported [15,17], The present study prospectively examines the diagnostic accuracy and feasibility of DSE as an alternative to exercise stress test ing for detect ing CAD in patients presenting for coronary angiography.…”

Sustained Nonischemic Ventricular Tachycardia during Dobutamine Stress Echocardiography

“…Ventricular tachycardia is an infrequent occur rence during dobutamine stress echocardiography, and when present, is invariably nonsustained and associated with cardiomyopathy, ischemia, myocardial infarction or other risk factors for ventricular tachycardia [3,10,11]. In nine previous reports involving over 1,100 patients.…”

“…The appeal for dobutamine stress echocardiography derives from its generation of incremental stress, safety, high predictive accuracy and minimal side effect profile [9][10][11]. Ventricular tachycardia is an infrequent occur rence during dobutamine stress echocardiography, and when present, is invariably nonsustained and associated with cardiomyopathy, ischemia, myocardial infarction or other risk factors for ventricular tachycardia [3,10,11].…”

The Value of Dobutamine Stress Echocardiography in Evaluation of Patients after the First Uncomplicated Acute Myocardial Infarction

“…Neither coro nary angiography nor myocardial perfusion scintigraphy is indicated or feasible in all patients. Stress echocardiography in general and dobutamine stress echocardiography (DSE) in particular have emerged lately as valuable methods to investigate this group of patients [2][3][4]. The aims of our study were: ( 1 ) risk stratifi cation of patients after a first uncomplicated AMI using DSE and SEE; (2) validation of DSE results with coronary angiography find ings regarding the extent and severity of coro nary artery disease (CAD), and (3) prognostic implications of DSE.…”