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Published on: February 10, 2013
Safety profile and hemodynamic responses to beta-adrenergic stimulation by dobutamine in heart transplant patients
K O Akosah1, B Denlinger, P K Mohanty
1Gundersen Lutheran Heart Institute, La Crosse, WI 54601, USA.
Insights
Heart transplant patients show an augmented heart rate response to dobutamine stress echocardiography (DSE). This heightened response, despite similar blood pressure changes, may increase myocardial oxygen demand and risk of ischemia.
Area of Science:
- Cardiology
- Transplant Medicine
- Diagnostic Imaging
Background:
- Dobutamine stress echocardiography (DSE) is utilized for coronary artery disease screening post-heart transplantation and for identifying cardiac event risks.
- The safety of high-dose dobutamine in heart transplant recipients, particularly concerning the influence of cardiac denervation, requires systematic evaluation.
Purpose of the Study:
- To systematically examine the safety profile and hemodynamic responses to escalating dobutamine doses in heart transplant patients.
- To determine the influence of cardiac denervation on these responses compared to innervated control subjects.
Main Methods:
- Assessed hemodynamic responses, heart rate (HR), and arterial blood pressure (BP) indexes (mean arterial pressure, systolic BP [SBP], diastolic BP [DBP], pulse pressure) to dobutamine.
- Studied 87 heart transplant patients and compared results with 97 nontransplant patients serving as innervated controls.
Main Results:
- Heart transplant patients exhibited significantly higher baseline and peak HR responses compared to nontransplant patients (p < 0.001).
- SBP was lower in heart transplant patients at baseline and peak, while baseline DBP was higher (p < 0.02).
- The decrease in DBP was similar in both groups; however, heart transplant patients showed a leftward-shifted HR dose-response curve with higher absolute HR and rates of increase.
Conclusions:
- Heart transplant patients demonstrate an augmented chronotropic response to dobutamine infusion.
- The observed increase in myocardial oxygen demand and potential decrease in coronary perfusion pressure may contribute to ischemic abnormalities detected via echocardiography.
Study Objective:
Dobutamine stress echocardiography (DSE) has been used as a screening tool for coronary artery disease after heart transplantation and in the identification of patients at risk for development of cardiac events. However, the safety profile of high-dose dobutamine in heart transplant patients has not been systematically examined. Accordingly, we studied the safety profile and hemodynamic responses to escalating doses of dobutamine to determine the influence of denervation.
Design:
We assessed the hemodynamic responses, heart rate (HR), and arterial BP indexes (mean arterial pressure, systolic BP [SBP], diastolic BP [DBP], and pulse pressure) to dobutamine in 87 heart transplant patients ([mean +/- SD] age, 51 +/- 1 years) and compared the results with 97 nontransplant patients (age, 63.0 +/- 1 years) who served as innervated control subjects.
Measurements And Results:
The baseline HR (84 +/- 2 vs 69 +/- 1 beats/minute, respectively; p < 0.001) and peak HR response (144 +/- 2 vs 117 +/- 2 beats/minute, respectively; p < 0.001) were significantly higher in heart transplant patients than in the nontransplant patients. SBP was lower in heart transplant patients than in nontransplant patients at baseline (131 +/- 2 vs 138 +/- 2 mm Hg, respectively; p < 0.02) and at peak (150 +/- 3 vs 158 +/- 3 mm Hg, respectively; p < 0.03). However, baseline DBP was higher in transplant patients than in nontransplant patients (86 +/- 1 vs 77 +/- 1 mm Hg, respectively; p < 0.001). The decrease in DBP was similar in both groups (15 mm Hg). The dose-response curve for HR was shifted leftward in heart transplant patients. Heart transplant patients attained a higher absolute HR at each infusion stage and higher rates of increase, but the decrease in DBP was not significantly different in the two groups.
Conclusions:
These results show that there is augmented chronotropic response and expected decline in DBP in response to dobutamine infusion in heart transplant patients. This increase in myocardial oxygen demand and a decrease in coronary perfusion pressure may be important mechanisms in the development of ischemic abnormalities that are detectable as regional dysynergy on echocardiography.
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