Cardiovascular medicine
Prolonged left ventricular dysfunction occurs in patients with
coronary artery disease after both dobutamine and exercise induced
myocardial ischaemia
E Barnesa, C S R Bakera, D P Dutkaa, O Rimoldib, C A Rinaldia, P Nihoyannopoulosa, P G Camicib, R J C Halla
a Department of
Cardiology, Imperial College School of Medicine, Hammersmith Hospital,
London W12 0NN, UK, b MRC Cyclotron Unit, Imperial College School
of Medicine, Hammersmith Hospital
Correspondence to: Dr Barnes
Accepted 29
October 1999
OBJECTIVE
To determine whether pharmacological stress
leads to prolonged but reversible left ventricular dysfunction in
patients with coronary artery disease, similar to that seen after exercise.
DESIGNA randomised crossover study of recovery time of
systolic and diastolic left ventricular function after exercise and
dobutamine induced ischaemia.
SUBJECTS10 patients with stable angina, angiographically
proven coronary artery disease, and normal left ventricular function.
INTERVENTIONSTreadmill exercise and dobutamine stress
were performed on different days. Quantitative assessment of systolic
and diastolic left ventricular function was performed using
transthoracic echocardiography at baseline and at regular intervals
after each test.
RESULTSBoth forms of stress led to prolonged but
reversible systolic and diastolic dysfunction. There was no difference
in the maximum double product (p = 0.53) or ST depression
(p = 0.63) with either form of stress. After exercise, ejection
fraction was reduced at 15 and 30 minutes compared with baseline (mean
(SEM), 
5.6 (1.5)%, p < 0.05; and 6.1 (2.2)%, p < 0.01),
and at 30 and 45 minutes after dobutamine (10.8 (1.8)% and 5.5
(1.8)%, both p < 0.01). Regional analysis showed a reduction in the
worst affected segment 15 and 30 minutes after exercise (27.9
(7.2)% and 28.6 (5.7)%, both p < 0.01), and at 30 minutes after
dobutamine (32 (5.3)%, p < 0.01). The isovolumic relaxation
period was prolonged 45 minutes after each form of stress
(p < 0.05).
CONCLUSIONSIn patients with coronary artery disease,
dobutamine induced ischaemia results in prolonged reversible left
ventricular dysfunction, presumed to be myocardial stunning, similar to
that seen after exercise. Dobutamine induced ischaemia could therefore
be used to study the pathophysiology of this phenomenon further in
patients with coronary artery disease.
Keywords: myocardial stunning; echocardiography; exercise; dobutamine
© 2000 by Heart
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
This article has been cited by other articles:
-
Noel, M., Jobin, J., Marcoux, A., Poirier, P., Dagenais, G. R., Bogaty, P.
(2007). Can prolonged exercise-induced myocardial ischaemia be innocuous?. Eur Heart J
28: 1559-1565
[Abstract] [Full Text] -
Camici, P. G, Rimoldi, O. E
(2003). Myocardial blood flow in patients with hibernating myocardium. Cardiovasc Res
57: 302-311
[Abstract] [Full Text] -
Barnes, E., Hall, R. J. C., Dutka, D. P., Camici, P. G.
(2002). Absolute blood flow and oxygenconsumption in stunned myocardiumin patients with coronary artery disease. J Am Coll Cardiol
39: 420-427
[Abstract] [Full Text] -
Camici, P. G., Dutka, D. P.
(2001). Repetitive stunning, hibernation, and heart failure: contribution of PET to establishing a link. Am. J. Physiol. Heart Circ. Physiol.
280: H929-H936
[Full Text] -
Barnes, E., Dutka, D. P., Khan, M., Camici, P. G., Hall, R. J.
(2002). Effect of repeated episodes of reversible myocardial ischemia on myocardial blood flow and function in humans. Am. J. Physiol. Heart Circ. Physiol.
282: H1603-H1608
[Abstract] [Full Text]
- Full Text
- Full Text (PDF)
- Submit a response
- Alert me when this article is cited
- Alert me when eLetters are posted
- Alert me if a correction is posted
- Citation Map
Services
- Email this link to a friend
- Similar articles in this journal
- Similar articles in PubMed
- Add article to my folders
- Download to citation manager
- Request Permissions
Citing Articles
Google Scholar
PubMed
Topic Collections
-
Drugs: cardiovascular system
-
Hypertension
-
Echocardiography
-
Acute coronary syndromes
- Clinical diagnostic tests
Bookmark with
Register for free content
The full back archive is now available for all BMJ Journals. Institutional subscribers may access the entire archive as part of their subscription. Personal subscribers will also have access to all content when logged in. Non-subscribers who register have free access to all articles published before 2006 right back to volume 1 issue 1. Register here to access the free archive of all BMJ Journals.
Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.
