Dobutamine stress echocardiography

Dobutamine is a synthetic catecholamine with predominant beta-stimulation. Its half-life is approximately 2 min. The positive chronotropic and inotropic effects of dobutamine induce myocardial ischaemia if significant coronary artery obstruction is present. Regional ischaemia produces regional wall motion abnormalities which can be detected by echocardiography. Most dobutamine stress protocols start at an infusion rate of 5 micrograms.kg-1.min-1 and increase to a peak dose of 40 or 50 micrograms.kg-1.min-1; to further increase heart rate, a bolus injection of 0.25-1.0 mg atropine is added. Test endpoints are the detection of new wall motion abnormalities, the occurrence of severe complications or achievement of the target heart rate. Viable myocardial regions have a positive inotropic reserve, which can be stimulated by dobutamine and detected by echocardiography. Indications for the use of dobutamine stress echocardiography are to prove stress-inducible myocardial ischaemia and to detect myocardial viability. The test should only be performed for the detection of stress-induced myocardial ischaemia if patients are unable to undergo exercise echocardiography, or if patients fail to reach their required test level in exercise echocardiography.