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dobutamine stress echocardiography

Indications: - evaluation of coronary artery disease (chest pain) - useful for patients unable to exercise - useful when information on an area of mycardium at risk is needed - useful for evaluation of cardiac valve function - useful for evaluation of pulmonary pressures - useful for stratifying risk in patients with known or suspected CAD [2] Contraindications: - severe baseline hypertension - unstable angina - arrhythmias, left bundle-branch block [1] Procedure: - withhold beta-blockers prior to testing [1] - dobutamine stress used in connection with echocardiography evaluates heart motion in resoponse to dobutamine - dobutamine may be supplemented with atropine to increase heart rate - the patient is supine - images are acquired continuously - dobutamine may be stopped when ischemia is evident Clinical significance: - in patients with significant coronary artery disease (CAD), dobutamine induces segmental wall motion abnormalities in the region of distribution of the diseased vessels - left ventricular dilatation occurs when large areas are involved - myocardial viability may be determined by identifying increased wall motion in myocardial segments akinetic at baseline - in contrast to exercise, maximal heart rate is not suppressed by beta-blockers - hypotension associated with dobutamine infusion may limit maximum dobutamine dosage, but has no diagnostic relevance - prognostic value similar to myocardial perfusion scintigraphy [3] Interpretation: resting image stress image interpretation normal normal no ischemia normal wall motion defect stress-induced ischemia wall motion defect wall motion defect myocardial infarct normal LV dilation * * small or no focal ischemia, possible diffuse ischemia, possible multivessel CAD * dobutamine-induced left ventricular dysfunction & or evidence of ischemia are independent predictors of cardiac mortality * ECG ST segment & T-wave changes with dobutamine infusion may indicate ischemia - they do NOT add to test accuracy (except for risk stratification) Complications: 1) atrial fibrillation 2) coronary vasospasm

Related

coronary artery disease; coronary atherosclerosis (CAD) dobutamine (Dobutrex)

General

pharmacologic stress testing stress echocardiography

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 17, 19. American College of Physicians, Philadelphia 1998, 2015, 2022
  2. Journal Watch 21(8):64, 2001 Marwick et al J Am Coll Cardiol 37:754, 2001
  3. Journal Watch 24(16):126, 2004
    1. Schinkel AF, Bax JJ, Elhendy A, van Domburg RT, Valkema R, Vourvouri E, Bountioukos M, Rizzello V, Biagini E, Agricola E, Krenning EP, Simoons ML, Poldermans D. Long-term prognostic value of dobutamine stress echocardiography compared with myocardial perfusion scanning in patients unable to perform exercise tests. Am J Med. 2004 Jul 1;117(1):1-9. PMID: 15210381 - Marwick TH. Does the extent of malperfusion or ischemia on stress testing predict future cardiac events? Am J Med. 2004 Jul 1;117(1):58-9. No abstract available. PMID: 15210390