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[Complications of stress echocardiography]
Y Hirano1, T Yamamoto, H Uehara
1First Department of Internal Medicine, Kinki University School of Medicine, Ohnohigashi 377-2, Osakasayama, Osaka 589-8511.
Insights
Stress echocardiography is a safe and effective method for detecting myocardial ischemia in patients with suspected coronary artery disease. While minor side effects like premature beats can occur, serious complications are rare, making it a reasonable diagnostic tool.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Clinical Medicine
Context:
- Stress echocardiography is a widely used diagnostic tool for coronary artery disease.
- Limited data exists on the safety of stress echocardiography in Japanese clinical settings.
- Assessing safety is crucial due to the invasive nature of some stress agents.
Purpose:
- To evaluate the feasibility, safety, and side effect profile of stress echocardiography.
- To document complications and adverse events associated with different stress modalities.
- To establish the safety of stress echocardiography for diagnosing myocardial ischemia.
Summary:
- A prospective study of 1,866 patients undergoing dobutamine, exercise, or dipyridamole echocardiography was conducted.
- Common side effects included ventricular premature beats and headache; serious adverse events were rare (0.05%).
- One case of acute myocardial infarction occurred with dipyridamole echocardiography, requiring intervention.
Impact:
- Stress echocardiography is confirmed as a safe and reasonable method for diagnosing myocardial ischemia.
- The study provides valuable safety data for stress echocardiography in a Japanese population.
- Findings support the continued use of stress echocardiography with awareness of potential minor side effects.
Background:
Stress echocardiography is an established clinical testing method and is accurate for the detection of coronary artery disease. Despite its widespread use, the safety of stress echocardiography has not been sufficiently documented in Japanese laboratories.
Objectives:
The feasibility, safety, complications and side effects of stress echocardiography were assessed for detecting myocardial ischemia in patients with suspected coronary artery disease.
Methods:
1,866 patients who underwent dobutamine echocardiography(n = 897), exercise echocardiography(n = 722), and dipyridamole echocardiography(n = 247) were prospectively studied from November 1990 to April 2000. Dobutamine was administered intravenously at 5, 10, 20, 30, 40 micrograms/kg/min in 3-minute intervals. Exercise echocardiography used the supine ergometer, starting at 50 W and increasing gradually by 25 W at 3-minute intervals to the maximum of 150 W. Dipyridamole was administered intravenously at 0.14 mg/kg/min for 4 min. After a 4-minute observation period, the drug was re-administered at the same dose for 2 min.
Results:
The most common side effects under each stress were ventricular premature beats in 34.1% (dobutamine echocardiography), ventricular premature beats in 14.4%(exercise), and headache in 24.3% (dipyridamole). Serious side effects occurred in one patient(0.05%). The case of acute myocardial infarction was caused by dipyridamole echocardiography, and the patient needed emergency coronary angioplasty. Seven patients needed other drug therapy for nonsustained ventricular tachycardia(one), paroxysmal supraventricular tachycardia(two), sinus bradycardia(three), and bronchial asthma(one). There was no incidence of death, shock, or ventricular fibrillation, sustained ventricular tachycardia or other conditions requiring inpatient observation during stress echocardiography.
Conclusions:
Stress echocardiography is a reasonable, safe method for determining myocardial ischemia, but may be associated with minor, self-limiting side effects.