Circulation, Vol 88, 15-19, Copyright © 1993 by American Heart Association
H Mertes, SG Sawada, T Ryan, DS Segar, R Kovacs, J Foltz and H Feigenbaum
BACKGROUND. The use of dobutamine stress echocardiography for the
evaluation of coronary artery disease is rapidly expanding. New
applications of the technique are being investigated in a wide variety of
patients including those with advanced coronary artery disease. Despite its
widespread use, the safety of dobutamine stress echocardiography has not
been sufficiently documented. METHODS AND RESULTS. A consecutive series of
1118 patients undergoing dobutamine stress echocardiography for evaluation
of known or suspected coronary artery disease form the basis of this
report. Dobutamine stress testing was performed for evaluation of chest
pain, risk assessment before noncardiac surgery, after recent myocardial
infarction, or as a part of ongoing research protocols. Over the study
period, the maximal dose of dobutamine used was increased from 30 to 50
micrograms/kg per minute, and atropine was used in 420 (37%) patients.
There were no occurrences of death, myocardial infarction, or episodes of
sustained ventricular tachycardia as a result of dobutamine stress testing.
The major reasons for test termination were achievement of target heart
rate in 583 patients (52.1%), maximum dose in 255 (22.8%), and angina
pectoris in 142 (13%). The test was terminated in 36 (3%) patients because
of noncardiac side effects including nausea, anxiety, headache, tremor, and
urgency. Angina pectoris occurred in 216 (19.3%) patients. Sublingual
nitroglycerin, a short-acting beta-blocker, or both types of medication
were administered in 80 of these patients for relief of angina pectoris.
None required intravenous nitroglycerin. A total of 736 (65%) patients had
stable sinus rhythm throughout the test. The most common arrhythmias were
frequent premature ventricular complexes (six or more per minute) in 172
patients (15%), and frequent premature atrial complexes in 86 (8%). There
were 40 patients with nonsustained ventricular tachycardia. None had
symptoms associated with the tachycardia, and only one received specific
pharmacological treatment to prevent recurrence of the arrhythmia after the
test was terminated. The patients who were evaluated after recent
myocardial infarction and those who received atropine did not have a higher
frequency of ventricular tachycardia compared with those without recent
infarction and those not receiving atropine. CONCLUSIONS. Dobutamine stress
echocardiography was safely performed using supplemental atropine and an
aggressive dosing protocol. Noncardiac side effects were usually minor.
Arrhythmias were well tolerated and rarely required treatment. In this
study, serious complications from myocardial ischemia did not occur.
Symptomatic ischemia was effectively treated with test termination,
sublingual nitroglycerin, or short-acting beta-blockers.
ARTICLES
Symptoms, adverse effects, and complications associated with dobutamine stress echocardiography. Experience in 1118 patients
Krannert Institute of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis.
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