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Safety and feasibility of dobutamine-atropine stress testing in hypertensive patients
A Elhendy1, R T van Domburg, J R Roelandt
1Thoraxcenter, University Hospital Rotterdam-Dijkzigt, Erasmus University, Netherlands.
Insights
Dobutamine stress testing is a safe and feasible method for evaluating coronary artery disease in hypertensive patients. While hypotension is more common, the test
Area of Science:
- Cardiology
- Diagnostic Imaging
- Hypertension Research
Background:
- Dobutamine stress testing is a key diagnostic tool for coronary artery disease.
- Hypertensive patients present unique considerations for stress testing due to altered hemodynamics.
Purpose of the Study:
- To evaluate the hemodynamic profile, safety, and feasibility of dobutamine stress testing in patients with hypertension.
- To compare these parameters between hypertensive and normotensive individuals.
Main Methods:
- Dobutamine-atropine stress echocardiography was performed in 1164 patients with limited exercise capacity, including 446 with hypertension.
- Feasibility was defined by achieving 85% of maximal heart rate or an ischemic endpoint.
- Hemodynamic parameters, adverse events, and feasibility rates were recorded and analyzed.
Main Results:
- The test was feasible in 91% of hypertensive and 92% of normotensive patients.
- Dobutamine significantly increased heart rate in both groups.
- Hypotension occurred more frequently in hypertensive patients (7% vs 4%), with baseline systolic pressure >140 mmHg, older age, and calcium channel blocker use as predictors.
Conclusions:
- Dobutamine-atropine stress echocardiography is a safe and feasible method for assessing myocardial ischemia in hypertensive patients.
- Despite a higher incidence of hypotension, the test's feasibility remains comparable to normotensive individuals.
Abstract:
Dobutamine stress testing is increasingly used for the diagnosis and functional evaluation of coronary artery disease. The aim of this study was to assess the hemodynamic profile, safety, and feasibility of dobutamine stress testing in hypertensive patients. Dobutamine (up to 40 micrograms/kg per minute)-atropine (up to 1 mg) stress echocardiography was performed for the detection of myocardial ischemia in 1164 patients with limited exercise capacity (age, 60 +/- 12 years; 761 men); 446 patients were known to have hypertension. The test was considered feasible when 85% of the maximal heart rate and/or an ischemic end point (new or worsened wall motion abnormalities, ST segment depression, or angina) was achieved. No myocardial infarction or death occurred during the test. Dobutamine induced a significant increase of heart rate in patients with and without hypertension (59 +/- 25 and 63 +/- 23 beats per minute, respectively). Peak rate pressure product was similar in patients with and without hypertension (18,566 +/- 4584 and 18,230 +/- 4508). Hypotension (systolic pressure drop > 40 mm Hg) during the test was more frequent in hypertensive patients (7% versus 4% in normotensive, P < .05). Independent predictors of hypotension were baseline systolic pressure greater than 140 mm Hg (odds ratio, 6.9; 95% confidence interval, 3.4 to 14), older age (odds ratio, 1.04; 95% confidence interval, 1.01 to 1.07), and medication with calcium channel blockers (odds ratio, 1.8; 95% confidence interval, 1.1 to 3.5). The prevalence of ventricular tachycardia was similar (4.1%) in both groups. Episodes of 10 beats or more (0.06% of patients) were terminated promptly by intravenous metoprolol administration. Dobutamine stress testing was considered feasible in 91% of patients with and 92% of patients without hypertension. Dobutamine-atropine stress echocardiography is a safe and feasible method for the assessment of hypertensive patients referred for evaluation of myocardial ischemia. Despite the higher prevalence of dobutamine-induced hypotension in these patients, the feasibility of the test is comparable to that in individuals without hypertension.