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Safety and feasibility of dobutamine-atropine stress echocardiography in patients with ischemic left ventricular
J H Cornel1, A H Balk, E Boersma
1Department of Cardiology, University Hospital Rotterdam-Dijkzigt, Erasmus University, The Netherlands.
Insights
High-dose dobutamine-atropine stress echocardiography is safe and feasible in patients with left ventricular dysfunction. This stress test can be safely performed even in patients with reduced ejection fraction, with only a slight decrease in feasibility.
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Imaging
Background:
- Left ventricular dysfunction (LVD) can complicate cardiac stress testing.
- The safety and feasibility of high-dose dobutamine-atropine stress echocardiography (H DASE) in patients with LVD require evaluation.
Purpose of the Study:
- To determine if LVD affects the safety and feasibility of H DASE.
- To assess the incidence of complications and test completion rates in patients with and without LVD.
Main Methods:
- Retrospective analysis of 318 patients undergoing H DASE and cardiac catheterization.
- Patients were categorized based on left ventricular ejection fraction (LVEF ≤ 25% vs. > 25%).
- Complications, arrhythmias, hypotension, and test feasibility were compared between groups.
Main Results:
- No serious complications (death, MI, VF) occurred in the entire cohort.
- Overall H DASE feasibility was excellent (97%).
- Patients with LVEF ≤ 25% had higher rates of tachyarrhythmias (14% vs. 5%, p=0.03) and slightly lower feasibility (89% vs. 97%, p<0.01), but no difference in hypotension.
Conclusions:
- Advanced LVD does not contraindicate H DASE.
- H DASE is a safe and feasible stress test for patients with LVD.
- History of tachyarrhythmias is the primary predictor of stress-induced arrhythmias.
Abstract:
The aim of this study was to analyze whether left ventricular dysfunction affects the safety and feasibility of high-dose dobutamine-atropine stress echocardiography. We examined the results of the test in 318 consecutive patients who were referred for high-dose dobutamine-atropine stress echocardiography and also underwent diagnostic cardiac catheterization. Forty-four patients had a left ventricular ejection fraction of 25% or less (mean, 21%; range, 15% to 25%). In the entire group of 318 patients, no serious complications (death, myocardial infarction, or ventricular fibrillation) occurred. The overall feasibility of completing the test was excellent (97%). A trial fibrillation occurred in four patients, nonsustained ventricular tachycardia in 12, and sustained ventricular tachycardia in one. A decrease in systolic blood pressure of greater than 40 mm Hg or a peak systolic pressure of less than 80 mm Hg was present in eight cases. In the group with an ejection fraction of 25% or less, there was a higher rate of significant tachyarrhythmias (14% versus 5%; p = 0.03), whereas the feasibility of the test was slightly lower (89%; p < 0.01), but no difference for hypotension was found. By multivariate analysis, a history of tachyarrhythmias was the only predictor of stress-induced arrhythmias. Advanced left ventricular dysfunction does not represent a contraindication for dobutamine-atropine stress testing.