[Pressor modification of pacemaker stress-echocardiograghy with the use of moderate diagnostic doses of dobutamine]

Supplementary infusion of moderate doses of dobutamine is proposed for obtaining inotropic hyperkinetic response in the process of pacemaker stress echocardiography with transesophageal electrical atrial pacing. With the aim of approbation of technology and assessment of diagnostic reliability of the suggested combination we examined 41 middle aged patients with known state of coronary vascular bed. Rate of dobutamine infusion was titrated in order to obtain pressor effect and achieve 30% or greater elevation of systemic arterial pressure from baseline level. For patients with body mass less than 80 kg dobutamine dose 20 g/kg/min was required, while for those with body mass more than 80 kg the dose 15 g/kg/min was turned out to be sufficient. Accelerated pacemaker 2 stage ischemic test was carried out at the background of permanent infusion of the selected dose of dobutamine. Realizability of the suggested protocol was 98%, sensitivity and specificity in diagnosis of mono and bivascular coronary artery stenoses - 90 and 95%, respectively. Concordance of hibernating regions to stenosed arteries was satisfactory (=0.69%). Duration of induction stage was 14 min. Mosaic hibernation of the myocardium developed under conditions of integral hyperkinesia of the cardiac muscle. No significant complications occurred.