Arbutamine echocardiography: Efficacy and safety of a new pharmacologic stress agent to induce myocardial ischemia and detect coronary artery disease (original) (raw)
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Comparison of Arbutamine and Exercise Echocardiography in Diagnosing Myocardial Ischemia
The American Journal of Cardiology, 1997
Arbutamine is a new catecholamine designed for use as a pharmacologic stress agent. This study compared the sensitivity of arbutamine with symptom-limited exercise to induce echocardiographic signs of ischemia. Arbutamine was administered by a computerized closed-loop delivery system that controls the infusion rate of arbutamine toward a predefined rate of heart rate increase and maximum heart rate limit. Beta blockers were
The American Journal of Cardiology, 1994
The purpose of this study was to establish the safety of high-dose dobutamine-atropine stress echocardiography in patients with suspected or proven coronary artery disease. Six hundred fifty consecutive examinations were completed. Mean age of patients was 61 years; 300 had a previous myocardial infarction. Heart rate increased from 73 to 129 beats/min during stress testing, blood pressure did not change significantly (from 140/81 to 150/80 mm Hg). Atropine was added to dobutamine in 239 patients when no ischemia was induced with dobutamine alone and the peak heart rate was < 85% of the theoretical maximal heart rate. Atropine was more frequently administered to patients taking beta blockers (77 vs 27%, p < 0.001). New wall motion abnormalities developed in 243 patients (37%). Significant or symptomatic cardiac tachyarrhythmias, or both, developed during 24 examinations: 1 patient developed ventricular fibrillation, 3 patients developed sustained ventricular tachycardia, 12 patients experienced nonsustained ventricular tachycardia (< 10 beats) and 8 patients had paroxysmal atrial fibrillation. Cardiac arrhythmias were more frequent in patients with a history of ventricular arrhythmias (ventricular tachycardia and fibrillation) (odds ratio 9.9, 2.0 to 45) or left ventricular dysfunction at rest (wall motion score > 1.12) (odds ratio 2.9, 1.1-7.6), but not associated with atropine addition. No death or myocardial infarction occurred. The full dose was not given to 13 patients despite absence of signs or markers of ischemia for limiting side effect, yielding an overall feasibility of the stress test of 98%.(ABSTRACT TRUNCATED AT 250 WORDS)
Feasibility, safety and tolerability of accelerated dobutamine stress echocardiography
Cardiovascular Ultrasound, 2007
A continuous infusion of a single high dose of dobutamine has been, recently, suggested as a simple and effective protocol of stress echocardiography. The present study assesses the feasibility, safety, and tolerability of an accelerated dobutamine stress protocol performed in patients with suspected or known coronary artery disease. Two hundred sixty five consecutive patients underwent accelerated dobutamine stress echocardiography: the dobutamine was administered at a constant dose of 50 μg/kg/min for up to 10 minutes. The mean weight-adjusted cumulative dose of dobutamine used was 330 ± 105.24 μg/kg. Total duration of dobutamine infusion was 6.6 ± 2.1 min. Heart rate rose from 69.9 ± 12.1 to 123.1 ± 22.1 beats/min at peak with a concomitant change in systolic blood pressure (127.6 ± 18.1 vs. 167.6 ± 45.0 mmHg). Dobutamine administration produced a rapid increase in heart rate (9.4 ± 5.9 beats/min 2 ). The side effects were similar to those described with the standard protocol; the most common were frequent premature ventricular complexes (21.5%), frequent premature atrial complexes (1.5%) and non sustained ventricular tachycardia (1.5%); among non cardiac symptoms the most frequent were nausea (3.4%), headache (1.1%) and symptomatic hypotension (1.1%). No major side effects were observed during the test. Our data demonstrate that a continous infusion of a single high dose of dobutamine is a safe and well tolerated method of performing stress echocardiography in patients with suspected or known coronary artery disease. This new protocol requires the administration of lower cumulative dobutamine dose than standard protocol and results in a significant reduction in test time.
Accuracy of dobutamine stress echocardiography in detecting coronary artery disease
The American Journal of Cardiology, 1992
The diagnostic accuracy of dobutamine stress echocardiography (DSE) (incremental infused doses of 5,10,20 and 30 &kg/min) was evaluated in 141 patients who underwent coronary arteriography within 2 weeks of DSE. All patients were being evaluated for known or suspected coronary artery disease (CAD). DSE was interpreted blindly as normal or showing evidence of CAD, depending on the presence of resting or inducible wall motion abnormalities. Coronary arteriograms were reviewed in a blinded, quantitative fashion. DSE had a sensftivity of 96% for detecting patients with CAD, and a specificity of 66%. For the 53 patients with normal resting wall motion, sensitivity was 87% and specificity 91%. The protocol was well-tolerated by all patients. In comparison with wall motion analysis, 124ead electrocardiograms during dobutamine infusion revealed ischemfc changes in only 17% of patients with CAD. It is concluded that DSE is a clinically useful and accurate means for detecting CAD, its specificity is hindered in patients with resting wall motion abnormalities, and it can safely be used in patients with known cardiac disease.
Heart (British Cardiac Society), 1998
To assess possible ECG changes caused by dobutamine stress and their relation to wall motion disturbances in patients with coronary artery disease. Prospective recording and analysis of 12 lead ECG at rest and during each stage of dobutamine stress echocardiography, and correlation with wall motion changes. A tertiary referral centre for cardiac disease equipped with non-invasive facilities for pharmacological stress tests. 27 patients, mean (SD) age 60 (8) years, with documented evidence of coronary artery disease in whom dobutamine stress echo was clinically indicated, and 17 controls of similar age. In controls, all ECG intervals shortened with increasing heart rate but in the patient group only PR and QT intervals shortened while QRS duration broadened and QTc interval prolonged progressively. In the 27 patients, 16 developed chest pain, 15 with reduced left ventricular long axis systolic excursion (p < 0.001), and all showed reduced peak lengthening rate; ST segment shift ap...