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Impact of Age on the Safety and the Hemodynamic Response Pattern During High Dose Dobutamine Echocardiography
Adrian Chenzbraun1, Zahi Khoury, Shmuel Gottlieb
1The Heiden Department of Cardiology, Bikur Cholim Hospital, 5 Strauss Street, P.O.B. 492, 91005 Jerusalem, Israel.
Insights
High-dose dobutamine echocardiography (DE) is safe across all age groups, showing a significant heart rate increase but a blunted blood pressure response in older patients. This diagnostic tool is effective for assessing coronary artery disease.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Pharmacology
Background:
- Dobutamine echocardiography (DE) is a common tool for diagnosing coronary artery disease.
- The safety and hemodynamic responses of high-dose DE in the very elderly are not well-established.
- Standardized blood pressure and heart rate responses for DE are lacking, particularly across different age demographics.
Purpose of the Study:
- To evaluate the safety and hemodynamic effects of high-dose dobutamine echocardiography (DE) in middle-aged, elderly, and very elderly patient groups.
- To determine if age influences the safety and response to high-dose DE.
- To establish benchmarks for blood pressure and heart rate changes during DE in diverse age populations.
Main Methods:
- Conducted high-dose dobutamine echocardiography (up to 50 µg/kg/min) in 400 patients across three age groups: middle-aged (<65), elderly (65-79), and very elderly (≥80).
- Monitored for side effects and recorded hemodynamic parameters, including heart rate and blood pressure.
- Analyzed the data to compare responses and safety profiles among the age groups.
Main Results:
- The study was discontinued due to side effects in 23% of patients; serious side effects occurred in 1.5%.
- A significant increase in heart rate (60% ± 35%) and a modest increase in blood pressure (10% ± 19%) were observed.
- While heart rate response was consistent across age groups, blood pressure response showed a blunting effect with increasing age, with hypotension linked to ischemia only in the very elderly.
Conclusions:
- High-dose dobutamine echocardiography (DE) is confirmed as safe for all evaluated age groups.
- Dobutamine primarily elicits a chronotropic (heart rate) response rather than a significant hypertensive (blood pressure) response.
- The very elderly exhibit a similar heart rate response to younger individuals, but a diminished blood pressure response compared to other age groups.
Abstract:
BACKGROUND: The purpose of the present study was to assess the safety and hemodynamic response of high dose dobutamine echocardiography (DE) in different age groups. DE is frequently used in the diagnosis of coronary artery disease; its safety in very elderly patients is not established, and there are no standards for blood pressure and heart rate response. METHODS AND RESULTS: The test was performed using up to 50 µg/kg/min in 400 patients: 164 middle-aged (age < 65 years), 187 elderly (age, 65-79 years), and 49 very elderly (age >/= 80 years). It was stopped because of side effects in 91 (23%) patients. Serious side effects occurred in 1.5% of the patients. There was a significant (60% +/- 35%) increase in heart rate, and a modest (10% +/- 19%) increase in the blood pressure (P <.001). The change in heart rate was similar in the three age groups, but there was a blunting of the blood pressure response with age. Hypotension was related to ischemia only in the very old. CONCLUSIONS: High-dose dobutamine is safe in all age groups. Dobutamine induces mainly a chronotropic and less a hypertensive response. The chronotropic response of the very old is similar with that of younger patients, but the hypertensive response is blunted in this group.