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Transthoracic coronary flow velocity reserve assessment: comparison between adenosine and dobutamine
Patrick Meimoun1, Smain Sayah, Jean Christophe Tcheuffa
1Department of Cardiology and Intensive Care Unit, Compiègne Hospital, Compiègne, France. patrickmeimoun@free.fr
Insights
Coronary flow velocity reserve (CFVR) assessed with dobutamine via transthoracic echocardiography (TTE) is comparable to adenosine. Dobutamine offers a viable alternative for TTE CFVR, especially for patients unable to use adenosine.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Noninvasive Cardiovascular Testing
Background:
- Coronary flow velocity reserve (CFVR) assessment using Doppler transthoracic echocardiography (TTE) typically employs adenosine.
- The utility of dobutamine for TTE CFVR measurement remains less established compared to adenosine.
Purpose of the Study:
- To compare the efficacy of dobutamine versus adenosine in assessing CFVR via TTE.
- To determine if dobutamine is a suitable alternative for CFVR measurement in patients undergoing noninvasive evaluation for coronary artery disease.
Main Methods:
- Prospective study of 47 stable patients in sinus rhythm.
- Coronary flow velocity measured in the left anterior descending (LAD) artery by TTE at rest and during adenosine infusion and dobutamine stress echocardiography (DSE).
- CFVR calculated as hyperemic to basal peak flow velocity (adenosine) and peak diastolic flow velocity divided by baseline diastolic flow velocity (dobutamine).
Main Results:
- Adequate CFVR recordings were achieved in 91% of patients with adenosine and 87% with dobutamine.
- CFVR values were comparable: 2.5 ± 0.7 with adenosine versus 2.4 ± 0.7 with dobutamine (P = .7).
- A strong linear correlation (r = 0.81, P < .0001) was observed between dobutamine and adenosine CFVR, including in patients with LAD stenosis.
Conclusions:
- Transthoracic echocardiography CFVR assessment using dobutamine is comparable to adenosine.
- Dobutamine serves as a practical alternative to adenosine for TTE CFVR, particularly for patients with contraindications to adenosine or those undergoing DSE.
Objective:
We sought to compare coronary flow velocity reserve (CFVR) with adenosine and dobutamine in patients scheduled for noninvasive evaluation of coronary artery disease.
Background:
Assessment of CFVR in the distal part of the left anterior descending coronary artery (LAD) by Doppler transthoracic echocardiography (TTE) is usually performed with adenosine in various settings. CFVR can also be determined during dobutamine stress echocardiography (DSE), but it has not been established whether TTE CFVR with dobutamine is equivalent to CFVR with adenosine.
Methods:
In all, 47 consecutive stable patients in sinus rhythm (28 men, 64 +/- 12 years, left ventricular ejection fraction 55 +/- 5%) were prospectively studied. Coronary flow velocity was measured in the distal part of the LAD by TTE, at rest and during continuous infusion of 0.14 mg/kg/min of adenosine over 2 minutes, and during DSE performed immediately after the adenosine test, using a multifrequency transducer, on a modified parasternal view. CFVR with adenosine was calculated as hyperemic to basal peak flow velocity. CFVR with DSE was obtained by calculating peak diastolic flow velocity divided by baseline diastolic flow velocity.
Results:
Adequate recording of CFVR with adenosine and dobutamine was possible in 43 (91%) and 41 (87%) patients, respectively. CFVR was 2.5 +/- 0.7 with adenosine compared with 2.4 +/- 0.7 with dobutamine (P = .7). A good linear correlation was observed between the two tests (r = 0.81, P < .0001). In patients with dobutamine-induced wall-motion abnormalities in the LAD territory (n = 8), CFVR was similar during dobutamine and adenosine infusion (1.6 +/- 0.3 vs 1.5 +/- 0.2, respectively, P = .7). Coronary angiography was available in 12 patients (LAD stenosis: 55 +/- 10% quantitative coronary angiography, with a range from 40%-75%). The correlation between CFVR values was also good in this subgroup of patients (r = 0.87, P < .0001).
Conclusion:
TTE CFVR with dobutamine is comparable to CFVR with adenosine in patients with a wide range of LAD diseases. Dobutamine could be a good alternative to adenosine for TTE CFVR assessment, particularly in patients with a contraindication to adenosine or scheduled for DSE.
