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Published on: February 10, 2013
Stroke volume changes during dobutamine-atropine stress echocardiography: the influence of heart rate and ischaemia
D Poldermans1, R Rambaldi, E Boersma
1Thoraxcentre, Erasmus University, Rotterdam, The Netherlands.
Background:
A decrease in stroke volume during dobutamine-atropine stress echocardiography heralds ischaemia and possible hypotension. Hypotension results from worsening of LV-function (as a result of ischaemia) left ventricular outflow tract obstruction or hypovolemia, while an increase of stroke volume indicates the preservation of myocardial contractile reserve.
Objective:
To assess stroke volume changes during dobutamine stress echocardiography in relation to heart rate and occurrence of ischaemia and to validate a new automated cardiac output measurement device.
Methods:
In fifty patients, the stroke volume was assessed using the echocardiographic biplane discs method during a stress echocardiography. These data were reference values for the validation of a new automated cardiac output measurement using the first method as a reference.
Results:
Stroke volume measured by the biplane discs method and automated cardiac output device decreased from rest to peak stress, respectively, from 54+/-16 to 34+/-9 (63%) ml and 63+/-17 to 38+/-15 (60%) ml (p < 0.001). Stroke volume decreased with increased heart rate and stress-induced ischaemia when assessed by the biplane discs method, but with the automated device it decreased only with increased heart rate.
Conclusions:
Both increased heart rate and myocardial ischaemia during dobutamine stress echocardiography cause a reduction of stroke volume. However, the automated device did not detect the effects of stress-induced ischaemia on stroke volume. It appears that the biplane discs method is more sensitive for evaluating the effect of ischaemia.
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