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Published on: February 10, 2013
Incidence and significance of profound hypotension during dobutamine stress echocardiography
M R Dhond1, T B Whitley, S Singh
1Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento 95817, USA.
Background:
Mild hypotension (drops of systolic blood pressure of > or = 20 mmHg) occurs in 14-38% of dobutamine stress echo (DSE) and carries a good prognosis for subsequent cardiac events. The incidence and significance of more profound hypotension (PH) (> or = 50 mmHg) is unknown.
Hypothesis:
The aim of the study was to determine the incidence of PH during DSE and its prognosis for subsequent cardiac events.
Methods:
We reviewed 617 DSE performed at our institution between 1992 and 1996 and identified two DSE subgroups. The first group (PH group) consisted of all patients with PH during DSE. A second group was selected with baseline characteristics similar to the PH group but without PH during DSE (non-PH group). Follow-up was by a physician chart review and direct telephone contact. Cardiac event rates were determined for hard [myocardial infarction (MI), or cardiac death] and soft (angina, congestive heart failure, coronary angioplasty, or coronary bypass surgery) events occurring after the DSE.
Results:
Of the 617 DSE performed, 16 (3%) patients developed PH (PH group) during DSE, with 13 showing no inducible ischemia. The hard and soft cardiac event rate in this 13 PH group was 46% (mean follow-up of 28.7 +/- 18 months). Of the non-PH group, 32 patients had a negative DSE with a coronary event rate of 12.5%. Profound hypotension correlated with a significantly higher cardiac event rate (p < 0.02).
Conclusions:
The incidence of PH during DSE is low (3%) and appears to predict a worse prognosis for subsequent cardiac events.
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