(Circulation. 1999;100:243-249.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Effects of Dobutamine on Coronary Stenosis Physiology and Morphology
Comparison With Intracoronary Adenosine
From the Cardiovascular Center, Aalst, Belgium.
Correspondence to Bernard de Bruyne, MD, PhD, Cardiovascular Center, OLV Ziekenhuis, Moorselbaan 164, B-9300 Aalst, Belgium. E-mail bernard.de.bruyne{at}olvz-aalst.be
Background—The mechanisms leading to dobutamine-induced ischemia are not fully understood. In the present study, we investigated the effects of high-dose intravenous dobutamine on morphological and physiological indexes of coronary stenoses.
Methods and Results—Twenty-two patients with normal left ventricular function and isolated coronary stenoses were studied. At catheterization, mean aortic pressure (Pa), mean distal coronary pressure (Pd), and Pd/Pa as an index of myocardial resistance were recorded at rest, after intracoronary adenosine, and during intravenous infusion of dobutamine (10 to 40 µg · kg-1 · min-1). Reference vessel diameter and minimal luminal diameter, as assessed by coronary angiography, did not change during dobutamine infusion compared with baseline (2.84±0.49 versus 2.77±0.41 mm and 1.35±0.38 versus 1.27±0.31 mm, respectively; both P=NS). During peak dobutamine infusion, Pd and Pd/Pa reached similar levels as during adenosine infusion (60±18 versus 59±18 mm Hg and 0.68±0.18 versus 0.68±0.17, respectively; all P=NS). In 9 patients, an additional bolus of intracoronary adenosine given at the peak dose of dobutamine failed to further decrease Pd/Pa. Furthermore, in patients with dobutamine-induced wall motion abnormalities, the maximal decrease in Pd/Pa was similar during dobutamine and adenosine infusions.
Conclusions—High-dose intravenous infusion of dobutamine does not modify the dimensions of the epicardial coronary stenosis. However, much like the direct coronary vasodilator adenosine, dobutamine fully exhausts myocardial resistance regardless of the presence of mechanical dysfunction.
Key Words: dobutamine • hemodynamics • ischemia • coronary disease • stress
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