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.
This article has been cited by other articles:
 |
|
 |
|
  R. Sicari, P. Nihoyannopoulos, A. Evangelista, J. Kasprzak, P. Lancellotti, D. Poldermans, J.-U. Voigt, J. L. Zamorano, and on behalf of the European Association of Echocardi Stress echocardiography expert consensus statement: European Association of Echocardiography (EAE) (a registered branch of the ESC) Eur J Echocardiogr, July 1, 2008; 9(4): 415 - 437. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P.A. Dijkmans, C.A. Visser, and O. Kamp Adverse reactions to ultrasound contrast agents: Is the risk worth the benefit? Eur J Echocardiogr, October 1, 2005; 6(5): 363 - 366. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. R. Rezaian, K. Aghasadeghi, and J. Kojuri Evaluation of the Hemodynamic Performance of St.Jude Mitral Prostheses: A Pilot Study by Dobutamine-Stress Doppler Echocardiography Angiology, January 1, 2005; 56(1): 81 - 86. [Abstract] [PDF]
|
|
|
|
 |
|
 D. G. Katritsis, I. Karabinos, A. Papadopoulos, P. Simeonidis, S. Korovesis, E. Giazitzoglou, E. Karvouni, and E. Voridis Sustained ventricular tachycardia induced by dobutamine stress echocardiography: A prospective study Europace, January 1, 2005; 7(5): 433 - 439. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Yip, B. Khandheria, M. Belohlavek, C. Pislaru, J. Seward, K. Bailey, A. J. Tajik, P. Pellikka, and T. Abraham Strain echocardiography tracks dobutamine-induced decrease in regional myocardial perfusion in nonocclusive coronary stenosis J. Am. Coll. Cardiol., October 19, 2004; 44(8): 1664 - 1671. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. Kadir, C. Walsh, P. Wilde, A. J. Bryan, and G. D. Angelini Comparison of exercise and dobutamine echocardiography in the haemodynamic assessment of small size mechanical aortic valve prostheses Eur. J. Cardiothorac. Surg., April 1, 2002; 21(4): 692 - 697. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. G. Fisher, H. Leong-Poi, T. Sakuma, S.-J. Rim, J. P. Bin, and S. Kaul Detection of coronary stenosis andmyocardial viability using a singleintravenous bolus injection of BR14 J. Am. Coll. Cardiol., February 6, 2002; 39(3): 523 - 529. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Tandogan, E. Yetkin, M. Ileri, H. Ortapamuk, A. Yanik, S. Cehreli, and E. Duru Diagnosis of Coronary Artery Disease with Tl-201 SPECT in Patients with Left Bundle Branch Block: Importance of Alternative Interpretation Approaches for Left Anterior Descending Coronary Lesions Angiology, February 1, 2001; 52(2): 103 - 108. [Abstract] [PDF]
|
|
|
|
 |
|
 K. D. Yi, H. F. Downey, X. Bian, M. Fu, and R. T. Mallet Dobutamine enhances both contractile function and energy reserves in hypoperfused canine right ventricle Am J Physiol Heart Circ Physiol, December 1, 2000; 279(6): H2975 - H2985. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. P. Rodgers, J. Z. Ayanian, G. Balady, J. W. Beasley, K. A. Brown, E. V. Gervino, S. Paridon, M. Quinones, R. C. Schlant, W. L. Winters Jr, et al. American College of Cardiology/American Heart Association Clinical Competence Statement on Stress Testing : A Report of the American College of Cardiology/American Heart Association/American College of Physicians-American Society of Internal Medicine Task Force on Clinical Competence Circulation, October 3, 2000; 102(14): 1726 - 1738. [Full Text] [PDF]
|
|
|
|
|
|
S. C. Smart, A. Bhatia, R. Hellman, T. Stoiber, A. Krasnow, B. D. Collier, and K. B. Sagar Dobutamine-atropine stress echocardiography and dipyridamole sestamibi scintigraphy for the detection of coronary artery disease: limitations and concordance J. Am. Coll. Cardiol., October 1, 2000; 36(4): 1265 - 1273. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. P. Rodgers, J. Z. Ayanian, G. Balady, J. W. Beasley, K. A. Brown, E. V. Gervino, S. Paridon, M. Quinones, R. C. Schlant, W. L. Winters Jr, et al. American College of Cardiology/American Heart Association clinical competence statement on stress testing: A report of the American College of Cardiology/American Heart Association/American College of Physicians-American Society of Internal Medicine Task Force on Clinical Competence J. Am. Coll. Cardiol., October 1, 2000; 36(4): 1441 - 1453. [Full Text] [PDF]
|
|
|
|
 |
|
 K. O. Akosah, B. Denlinger, and P. K. Mohanty Safety Profile and Hemodynamic Responses to {beta}-Adrenergic Stimulation by Dobutamine in Heart Transplant Patients* Chest, December 1, 1999; 116(6): 1587 - 1592. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K.-C. Hung, F.-C. Lin, M.-S. Chern, H.-J. Chang, I.-C. Hsieh, and D. Wu Mechanisms and clinical significance of transient atrioventricular block during dobutamine stress echocardiography J. Am. Coll. Cardiol., October 1, 1999; 34(4): 998 - 1004. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Gibbons, K. Chatterjee, J. Daley, J. S. Douglas, S. D. Fihn, J. M. Gardin, M. A. Grunwald, D. Levy, B. W. Lytle, R. A. O'Rourke, et al. ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Chronic Stable Angina) J. Am. Coll. Cardiol., June 1, 1999; 33(7): 2092 - 2197. [Full Text] [PDF]
|
|
|
|
|
|
J. F. Lewis, L. Lin, S. McGorray, C. J. Pepine, M. Doyle, D. Edmundowicz, R. Holubkov, G. Pohost, N. Reichek, W. Rogers, et al. Dobutamine stress echocardiography in women with chest pain: Pilot phase data from the National Heart, Lung and Blood Institute Women's Ischemia Syndrome Evaluation (WISE) J. Am. Coll. Cardiol., May 1, 1999; 33(6): 1462 - 1468. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. J. Scanlon, D. P. Faxon, A.-M. Audet, B. Carabello, G. J. Dehmer, K. A. Eagle, R. D. Legako, D. F. Leon, J. A. Murray, S. E. Nissen, et al. ACC/AHA guidelines for coronary angiography: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography) developed in collaboration with the Society for Cardiac Angiography and Interventions J. Am. Coll. Cardiol., May 1, 1999; 33(6): 1756 - 1824. [Full Text] [PDF]
|
|
|
|
|
|
E. Nagel, H. B. Lehmkuhl, W. Bocksch, C. Klein, U. Vogel, E. Frantz, A. Ellmer, S. Dreysse, and E. Fleck Noninvasive Diagnosis of Ischemia-Induced Wall Motion Abnormalities With the Use of High-Dose Dobutamine Stress MRI : Comparison With Dobutamine Stress Echocardiography Circulation, February 16, 1999; 99(6): 763 - 770. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C.-Y. Lee, P. A. Pellikka, R. B. McCully, D. W. Mahoney, and J. B. Seward Nonexercise stress transthoracic echocardiography: transesophageal atrial pacing versus dobutamine stress J. Am. Coll. Cardiol., February 1, 1999; 33(2): 506 - 511. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Cortigiani, E. A. Paolini, and E. Nannini Dipyridamole Stress Echocardiography for Risk Stratification in Hypertensive Patients With Chest Pain Circulation, December 22, 1998; 98(25): 2855 - 2859. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J A S. Román, I Vilacosta, J A Castillo, M J Rollán, M Hernández, V Peral, I Garcimartín, M d. M. de la Torre, and F Fernández-Avilés Selection of the optimal stress test for the diagnosis of coronary artery disease Heart, October 1, 1998; 80(4): 370 - 376. [Abstract] [Full Text]
|
|
|
|
 |
|
 Y. Genma, S. Ogawa, J. Zhang, and M. Yamamoto Evaluation of myocardial ischemia in Kawasaki disease by dobutamine stress signal-averaged ventricular late potentials Cardiovasc Res, December 1, 1997; 36(3): 323 - 329. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Cohen, C. Chauvel, B. Benhalima, P. Guyon, I. Desert, J. Valty, and A. Cohen Is Dobutamine Stress Echocardiography Useful for Noninvasive Differentiation of Ischemic from Idiopathic Dilated Cardiomyopathy? Angiology, September 1, 1997; 48(9): 783 - 793. [Abstract] [PDF]
|
|
|
|
|
|
M. L. Geleijnse, A. Elhendy, R. T. van Domburg, J. H. Cornel, R. Rambaldi, A. Salustri, A. E. M. Reijs, J. R. T. C. Roelandt, and P. M. Fioretti Cardiac Imaging for Risk Stratification With Dobutamine-Atropine Stress Testing in Patients With Chest Pain : Echocardiography, Perfusion Scintigraphy, or Both? Circulation, July 1, 1997; 96(1): 137 - 147. [Abstract] [Full Text]
|
|
|
|
 |
|
 A. Elhendy, R. T. van Domburg, J. R. T. C. Roelandt, M. L. Geleijnse, M. M. Ibrahim, and P. M. Fioretti Safety and Feasibility of Dobutamine-Atropine Stress Testing in Hypertensive Patients Hypertension, June 1, 1997; 29(6): 1232 - 1239. [Abstract] [Full Text]
|
|
|
|
 |
|
 I. Kadir, M. B. Izzat, P. Wilde, B. Reeves, A. J. Bryan, and G. D. Angelini Dynamic Evaluation of the 21-mm Medtronic Intact Aortic Bioprosthesis by Dobutamine Echocardiography Ann. Thorac. Surg., April 1, 1997; 63(4): 1128 - 1132. [Abstract] [Full Text]
|
|
|
|
|
|
S. C. Smart, T. Knickelbine, T. R. Stoiber, M. Carlos, J. C. Wynsen, and K. B. Sagar Safety and Accuracy of Dobutamine-Atropine Stress Echocardiography for the Detection of Residual Stenosis of the Infarct-Related Artery and Multivessel Disease During the First Week After Acute Myocardial Infarction Circulation, March 18, 1997; 95(6): 1394 - 1401. [Abstract] [Full Text]
|
|
|
|
 |
|
 M. B. Izzat, I. Birdi, P. Wilde, A. J. Bryan, and G. D. Angelini COMPARISON OF HEMODYNAMIC PERFORMANCES OF ST. JUDE MEDICAL AND CARBOMEDICS 21 MM AORTIC PROSTHESES BY MEANS OF DOBUTAMINE STRESS ECHOCARDIOGRAPHY J. Thorac. Cardiovasc. Surg., February 1, 1996; 111(2): 408 - 415. [Abstract] [Full Text]
|
|
|
|
|
|
S. Carstensen, S. M. Ali, F. V. Stensgaard-Hansen, J. Toft, S. Haunso, H. Kelbęk, and K. Saunamaki Dobutamine-Atropine Stress Echocardiography in Asymptomatic Healthy Individuals : The Relativity of Stress-Induced Hyperkinesia Circulation, December 15, 1995; 92(12): 3453 - 3463. [Abstract] [Full Text]
|
|
|
|
|
|
M. B. Izzat, I. Birdi, P. Wilde, A. J. Bryan, and G. D. Angelini Evaluation of the Hemodynamic Performance of Small CarboMedics Aortic Prostheses Using Dobutamine-Stress Doppler Echocardiography Ann. Thorac. Surg., October 1, 1995; 60(4): 1048 - 1052. [Abstract] [Full Text]
|
|