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Does dobutamine stress echocardiography induce damage during viability diagnosis of patients with chronic regional
S Beckmann1, W Bocksch, C Müller
1Department of Cardiology, Virchow Clinic and German Heart Institute Berlin.
Insights
Dobutamine stress echocardiography did not induce myocardial necrosis in patients with coronary artery disease. Cardiac enzyme levels remained within normal ranges, indicating no myocardial damage occurred during the dobutamine infusion protocol.
Area of Science:
- Cardiology
- Echocardiography
- Biomarkers
Background:
- Animal studies suggest longer-term intracoronary dobutamine infusion can induce myocardial necrosis.
- Coronary artery disease (CAD) patients with chronic regional wall motion abnormalities and significant stenosis are susceptible to myocardial events.
Purpose of the Study:
- To determine if dobutamine stress echocardiography (DSE) can ascertain myocardial infarction in patients with established CAD.
- To investigate the potential for DSE to induce myocardial necrosis in this patient population.
Main Methods:
- Twenty patients with CAD and regional resting wall motion abnormalities underwent a standard DSE protocol (5–50 microg/kg/min).
- Exclusion criteria included acute coronary syndrome, severe heart failure, and severe hypertension.
- Serum markers including creatine kinase (CK, CKMB), myoglobin, and troponin-I were measured pre-infusion and for 7 hours post-infusion.
Main Results:
- Fourteen out of 20 patients showed viable myocardium on DSE.
- No significant increase in serum cardiac biomarkers (CK, CKMB, myoglobin, troponin-I) was observed above reference ranges.
- The DSE protocol used did not induce myocardial necrosis in the study cohort.
Conclusions:
- Dobutamine stress echocardiography, using the described protocol, appears safe in patients with chronic regional wall motion abnormalities and significant coronary stenosis.
- This study suggests that DSE does not provoke myocardial necrosis in patients with established coronary artery disease under the tested conditions.
Abstract:
Experimental hibernating-model investigations of animals have shown that myocardial necrosis can be induced by longer-term intracoronary dobutamine infusion. This study was designed to determine whether myocardial infarction could be ascertained in patients with chronic regional wall motion abnormalities and greater than 75% stenosis in the supplying coronary artery through dobutamine stress echocardiography. Twenty patients with coronary artery disease and regional resting wall motion abnormalities were examined with a standard dobutamine protocol (5 to 50 microg/kg/min). Exclusion criteria were an acute coronary syndrome, severe heart failure, and severe hypertension. Creatine kinase (CK, CKMB), myoglobin, and troponine-I were measured before and at each of the first 7 hours after beginning of infusion. Fourteen of these 20 patients exhibited viable myocardium. The serum markers CK, CKMB, myoglobin, and troponin-I demonstrated no increase beyond the reference range, suggesting that with this protocol, no myocardial necrosis was induced.