Stress echocardiography

Relatively selective stimulation of Pi-adrenergic receptors can be achieved with dobutamine. This is a racemic drug of which both isomers activate the Pi-receptor, and in addition the (-) isomer activates ( -receptors whereas the (+) isomer activates p2-receptors the simultaneous activation of ai- and p2-receptors results in no major net effect on peripheral resistance, and thus the overall cardiovascular effects are mediated by Pi-stimulation leading to increases in cardiac contractility and output. Dobutamine is used for the short-term treatment of acute cardiac failure and for diagnostic purposes in stress echocardiography. 

Wall motion abnormalities or left ventricular dilation with stress echocardiography are indicative of IHD. 

Echocardiography is useful if the history or physical findings suggest valvular pericardial disease or ventricular dysfunction. In patients unable to exercise, pharmacologic stress echocardiography (e.g., dobutamine, dipyridamole, or adenosine) may identify abnormalities that would occur during stress. 

Mechanism of Action A cardiac agent that slows impulse formation in the SA node and conduction time through the AV node. Adenosine also acts as a diagnostic aid in myocardial perfusion imaging or stress echocardiography. Therapeutic Effect Depresses left ventricular function and restores normal sinus rhythm. 

If a patient is unable to perform an exercise test because of mobility problems, a pharmacologic stress test should be utilized (e.g., Dobutamine stress echocardiography).A man who cannot achieve 3-4 METs should be further evaluated by angiography if appropriate (3). 

Friart A, Hermans L, De Valeriola Y. Unusual side-effect of a dobutamine stress echocardiography. Am J Noninvasive Cardiol 1993 7 63M. 

A 43-year-old man had an acute myocardial infarction immediately after exercise and pharmacological stress echocardiography with dipyridamole + atropine 1 month after successful stent implantation (9). 

The value and safety of dobutamine stress echocardiography have been studied in 135 patients aged 70 years or older (mean age 74 years 58% men) soon after... 

Myocardial ischemia has also been reported in susceptible patients. A Japanese group carried out dobutamine stress echocardiography in 51 patients with a presumptive diagnosis of variant angina (17). All had coronary vasospasm in response to intracoronary acetylcholine and seven also had chest pain and reversible ST segment elevation. One must incidentally wonder whether this procedure was entirely advisable. 

In one study 38% of patients undergoing dobutamine stress echocardiography developed hypotension. Increases in blood pressure are more in hne with what one would expect. Although dobutamine does not as a rule cause a marked increase in systolic blood pressure in normotensive patients, hjrpertensive patients can develop marked systolic hypertension during an infusion of the drug. When stress echocardiography with dobutamine is performed in subjects who prove to be entirely healthy, an audible Still s-like vibratory systolic ejection murmur is nevertheless produced. 

Lattanzi F, Picano E, Adamo E, Varga A. Dobutamine stress echocardiography safety in diagnosing coronary artery disease. Drug Saf 2000 22(4) 251-62. 

Previtali M, Scelsi L, Sebastian R, Lanzarini L, Raisaro A, Klersy C. Feasibility, safety, and prognostic value of dobutamine stress echocardiography in patients > or = 70 years of age early after acute myocardial infarction. Am J Cardiol 2002 90(7) 792-5. 

Poldermans D, Rambaldi R, Bax JJ, Cornel JH, Thomson IR, Valkema R, Boersma E, Fioretti PM, Breburda CS, Roelandt JR. Safety and utility of atropine addition during dobutamine stress echocardiography for the assessment of viable myocardium in patients with severe left ventricular dysfunction. Eur Heart J 1998 19(11) 1712-18. 

Burger AJ, Notarianni MP, Aronson D. Safety and efficacy of an accelerated dobutamine stress echocardiography protocol in the evaluation of coronary artery disease. Am J Cardiol 2000 86(8) 825-9. 

Kawano H, Fuji H, Motoyama T, Kugiyama K, Ogawa H, Yasue H. Myocardial ischemia due to coronary artery spasm during dobutamine stress echocardiography. Am J Cardiol 2000 85(1) 26-30. 

Beckmann S, Bocksch W, Muller C, Schartl M. Does dobutamine stress echocardiography induce damage during via-bihty diagnosis of patients with chronic regional dysfunction after myocardial infarction J Am Soc Echocardiogr 1998 ll(2) 181-7. 

Geleijnse ML, Fioretti PM, Roelandt JRTC. Methodology, feasibihty, safety and diagnostic accuracy of dobutamine stress echocardiography. J Am Coll Cardiol 1997 30 595-606. 

Sicari R, Picano E, Landi R et al. Prognostic value of dobutamine-atropine stress echocardiography early after acute myocardial infarction. J Am Coll Cardiol 1997 29 254-260. 

Beleshn BD, Ostojic M, Stepanovic J, et al. Stress echocardiography in the detection of myocardial ischemia Head to toe comparison of exercise, dobutamine, and dipyridamole test. Circulation 1994 90 1168—1176. 

The vessels to be dilated must su btend at least a moderate area of viable myocardium In the physician s judgment, there should be evidence of myocardial ischemia such as ECG exercise testing, stress nuclear imaging, stress echocardiography, ambulatory ECG monitoring, or intracoronary physiologic measu rements... 

Marcovitz PA, Shayna V, Horn RA, et al. Value of dobu-tamine stress echocardiography in determining the prognosis of patients with known or suspected coronary artery disease. Am J Caridol 1996 78(4) 404-8. 

Ahmad M, Xie T, McCulloch M, Abreo G, Runge M (2001) Realtime three-dimensional dobutamine stress echocardiography in assessment stress echocardiography in assessment of ischemia comparison with two-dimensional dobutamine stress echocardiography. J Am Coll Cardiol 37 1303-1309... 

Systematic reviews In a review of dobutamine-I-atropine stress echocardiography data on the incidences of complications were obtained from 26 studies in over 400 patients, in which at least the major... 

Geleijnse ML, Krenning BJ, Nemes A, van Dalen BM, Soliman OI, Ten Cate FJ, Schinkel AF, Boersma E, Simoons ML. Incidence, pathophysiology, and treatment of complications during dobutamine-atropine stress echocardiography. Circulation 2010 121(15) 1756-67. 

Wilson ME, Lee GK, Chandra A, Kane GC. Central anticholinergic syndrome following dobutamine-atropine stress echocardiography. Echocardiography 2011 28(10) E205-6. 

Risk Factors of LEAD Co-Existing With Coronary Artery Disease Other Than Over 40 Years of Age What Do Patients With Lower Extremity Arterial Disease Assessed With a Low Ankle-Brachial Index Die From Dobutamine Stress Echocardiography Management... 

Reversible severe left ventricular systolic dysfunction with apical ballooning has abo been reported during dobutamine stress echocardiography [45, 46, 47, 48, 49, 50, 51, 52, 53, 54 ] and abo in one case after recovery from stress echocardiography [55 ]. In one case it occurred in a patient with previous orthotopic heart transplantation [56 ]. In another case it occurred in a patient who had had a subarachnoid haemorrhage [57 ], in which sympathetic nervous system activity b increased and in which acute myocardial infarction can abo occur. 

Death due to rupture of a splenic artery aneurysm occurred during dobutamine -I-atropine stress echocardiography in a 55-year-old man [91 ]. 

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