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Updated: May 30, 2026
Cardiac Stress Test Induced by Dobutamine and Monitored by Cardiac Catheterization in Mice
Published on: February 10, 2013
Dynamic changes in microcirculatory blood flow during dobutamine stress assessed by quantitative myocardial contrast
Wilson Mathias1, Ingrid Kowatsch, Ally Nader Saroute
1Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
Insights
Dobutamine-atropine stress echocardiography (DASE) with quantitative real-time myocardial contrast echocardiography (RTMCE) reveals dynamic microcirculatory changes in coronary artery disease (CAD). The replenishment velocity of microbubbles (β) reserve is the best parameter for detecting CAD during DASE.
Area of Science:
- Cardiology
- Medical Imaging
- Physiology
Background:
- Dobutamine-atropine stress echocardiography (DASE) is a common method for evaluating coronary artery disease (CAD).
- However, dynamic microcirculatory changes during DASE have not been well-demonstrated in humans.
Purpose of the Study:
- To quantify myocardial blood flow (MBF) variations throughout DASE stages using RTMCE.
- To assess the diagnostic utility of MBF parameters in detecting CAD.
Main Methods:
- 45 patients underwent coronary angiography and RTMCE.
- Replenishment velocity of microbubbles (β) and MBF reserves were measured at baseline, intermediate stress, peak stress, and recovery.
- Statistical analysis included comparisons between CAD and non-CAD groups and receiver operating characteristic (ROC) curve analysis.
Main Results:
- Patients with CAD showed significantly lower β and MBF reserves at intermediate and peak stress compared to those without CAD.
- In non-CAD patients, β and MBF reserves increased from intermediate to peak stress and decreased during recovery.
- Optimal cutoff values for β reserve demonstrated good diagnostic performance, with peak stress showing the highest accuracy (89%).
Conclusions:
- RTMCE enables dynamic quantification of microcirculatory blood flow during DASE.
- The β reserve is a valuable parameter for detecting CAD across all stages of DASE, particularly at peak stress.
Background:
Although dobutamine-atropine stress echocardiography (DASE) has been widely used for evaluating patients with coronary artery disease (CAD), dynamic changes that occur at microcirculatory level during each stage of stress have not been demonstrated in humans.
Aim:
We sought to determine variations in myocardial blood flow (MBF) during DASE using quantitative real time myocardial contrast echocardiography (RTMCE).
Methods:
We studied 45 patients who underwent coronary angiography and RTMCE. Replenishment velocity of microbubbles in the myocardium (β) and MBF reserves were obtained at baseline, intermediate stage (70% of maximal predicted heart rate), peak stress, and recovery phase.
Results:
β and MBF reserves were lower in patients with than without CAD at intermediate (1.65 vs. 2.10; P=0.001 and 2.44 vs. 3.23; P=0.004) and peak (1.63 vs. 3.00; P<0.001 and 2.14 vs. 3.98; P<0.001, respectively). In patients without CAD, β, and MBF reserves increased from intermediate to peak and decreased at recovery, while in those without CAD reserves did not change significantly. Optimal cutoff values of β reserve at intermediate, peak, and recovery were 1.78, 2.09, and 1.70, with areas under the curves of 0.80 (95%CI=0.67-0.94), 0.89 (95%CI=0.79-0.99), and 0.69 (95%CI=0.53-0.85). Sensitivity, specificity and accuracy for detecting CAD at intermediate stage were 68% (95%CI=48-89), 85% (95%CI=71-98), and 78% (95%CI=66-90), at peak stress were 79% (95%CI=61-97), 96% (95%CI=89-100), and 89% (95%CI=80-98), and at recovery were 74% (95%CI=54-93), 65% (95%CI=47-84), and 69% (95%CI=55-82), respectively.
Conclusion:
RTMCE allows for quantification of dynamic changes in microcirculatory blood flow at each stage of DASE. The best parameter for detecting CAD in all stages was β reserve.
