[Symptoms, complications and hemodynamic changes related to dobutamine stress echocardiography]

This study focuses on the safety and hemodynamic effects of dobutamine stress echocardiography.

Seven hundred and thirty five consecutive patients underwent dobutamine stress echocardiography for the evaluation of coronary artery disease and or cardiomyopathy. Dobutamine was administered intravenously at incremental doses of 5, 10, 20, 30 micrograms/kg/min, at 3 min intervals. The maximal dose was 40 or 50 micrograms/kg/min.

Dobutamine significantly (p < 0.0005) increased the heart rate (from 72 +/- 12 bpm to 117 +/- 23 bpm), systolic blood pressure (from 133 +/- 21 to 157 +/- 29 mmHg) and the rate-pressure product (from 9.635 +/- 2.100 to 18.400 +/- 4.050, p < 0.0001) from baseline to peak infusion rate, respectively. There was a significant increase in heart rate (p < 0.05) at each infusion step, except for the 50 micrograms/kg/min dose, when the heart became stable. There were no deaths myocardial infarctions, or episodes of sustained ventricular tachycardia. Common non cardiac side effects included nausea, anxiety, headache, tremors and urgency in 55 (7.4%) of the patients. Angina pectoris occurred in 10 (1.4%) of the patients. The most common arrhythmias were usually mild.

Dobutamine stress echocardiography is safe, and well tolerated. In this study complications such as myocardial infarction, death, ventricular tachycardia or fibrillation did not occur. There was no additional increase in heart rate with doses greater than 40 micrograms/kg/min. The advantage of stress echocardiography protocol with peak doses of 50 micrograms/kg/min is questionable.