dobutamine stress echocardiography
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Indications
- evaluation of coronary artery disease (chest pain)
- useful for patients unable to exercise
- useful when information on an area of mycardium at risk is needed
- useful for evaluation of cardiac valve function
- useful for evaluation of pulmonary pressures
- useful for stratifying risk in patients with known or suspected CAD[2]
Contraindications
- severe baseline hypertension
- unstable angina
- arrhythmias, left bundle-branch block[1]
Clinical significance
- in patients with significant coronary artery disease (CAD), dobutamine induces segmental wall motion abnormalities in the region of distribution of the diseased vessels
- left ventricular dilatation occurs when large areas are involved
- myocardial viability may be determined by identifying increased wall motion in myocardial segments akinetic at baseline
- in contrast to exercise, maximal heart rate is not suppressed by beta-blockers
- hypotension associated with dobutamine infusion may limit maximum dobutamine dosage, but has no diagnostic relevance
- prognostic value similar to myocardial perfusion scintigraphy[3]
Procedure
- withhold beta-blockers prior to testing[1]
- dobutamine stress used in connection with echocardiography evaluates heart motion in resoponse to dobutamine
- dobutamine may be supplemented with atropine to increase heart rate
- the patient is supine
- images are acquired continuously
- dobutamine may be stopped when ischemia is evident
Interpretation
Table
| resting image | stress image | interpretation |
|---|---|---|
| normal | normal | no ischemia |
| normal | wall motion defect | stress-induced ischemia |
| wall motion defect | wall motion defect | myocardial infarct |
| normal | LV dilation | * |
* small or no focal ischemia, possible diffuse ischemia, possible multivessel CAD
* dobutamine-induced left ventricular dysfunction & or evidence of ischemia are independent predictors of cardiac mortality
* ECG ST segment & T-wave changes with dobutamine infusion may indicate ischemia
- they do NOT add to test accuracy (except for risk stratification)
Complications
More general terms
Additional terms
References
- ↑ 1.0 1.1 1.2 Medical Knowledge Self Assessment Program (MKSAP) 11, 17, 19. American College of Physicians, Philadelphia 1998, 2015, 2022
- ↑ 2.0 2.1 Journal Watch 21(8):64, 2001 Marwick et al J Am Coll Cardiol 37:754, 2001
- ↑ 3.0 3.1 Journal Watch 24(16):126, 2004 a) Schinkel AF, Bax JJ, Elhendy A, van Domburg RT, Valkema R, Vourvouri E, Bountioukos M, Rizzello V, Biagini E, Agricola E, Krenning EP, Simoons ML, Poldermans D. Long-term prognostic value of dobutamine stress echocardiography compared with myocardial perfusion scanning in patients unable to perform exercise tests. Am J Med. 2004 Jul 1;117(1):1-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15210381
Marwick TH. Does the extent of malperfusion or ischemia on stress testing predict future cardiac events? Am J Med. 2004 Jul 1;117(1):58-9. No abstract available. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15210390