Safety and feasibility of dobutamine-atrophine stress echocardiography in patients with ischemic left ventricular dysfunction

doi:10.1016/S0894-7317(96)90101-7

Journal of the American Society of Echocardiography

Volume 9, Issue 1, January–February 1996, Pages 27-32

https://doi.org/10.1016/S0894-7317(96)90101-7 Get rights and content

Abstract

The aim of this study was to analyze whether left ventricular dysfunction affects the safety and feasibility of high-dose dobutamine-atropine stress echocardiography. We examined the results of the test in 318 consecutive patients who were referred for high-dose dobutamine-atropine stress echocardiography and also underwent diagnostic cardiac catheterization. Forty-four patients had a left ventricular ejection fraction of 25% or less (mean, 21%; range, 15% to 25%). In the entire group of 318 patients, no serious complications (death, myocardial infarction, or ventricular fibrillation) occurred. The overall feasibility of completing the test was excellent (97%). Atrial fibrillation occurred in four patients, nonsustained ventricular tachycardia in 12, and sustained ventricular tachycardia in one. A decrease in systolic blood pressure of greater than 40 mm Hg or a peak systolic pressure of less than 80 mm Hg was present in eight cases. In the group with an ejection fraction of 25% or less, there was a higher rate of significant tachyarrhythmias (14% versus 5%; p = 0.03), whereas the feasibility of the test was slightly lower (89%; p < 0.01), but no difference for hypotension was found. By multivariate analysis, a history of tachyarrhythmias was the only predictor of stress-induced arrhythmias. Advanced left ventricular dysfunction does not represent a contraindication for dobutamine-atropine stress testing.

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Citation Excerpt :
After screening titles and abstracts, 35 citations were considered potentially eligible and the full-text article was retrieved. Of those, 7 citations were excluded, resulting in 28 selected studies to which we added our present study (Figure 2).3–30 Thus, we calculated a combined incidence of AF during DSE from a total of 29 studies.
Dobutamine stress echocardiography (DSE) is a widely used examination for assessment of coronary ischemia, but several complications have been reported. The aim of this study was to assess the incidence of atrial fibrillation (AF) during DSE, and a systematic review and meta-analysis were also performed to determine an accurate estimate of the AF incidence. Over a 16-year period, we reviewed all patients referred for DSE. We systematically analyzed all ECG performed during DSE to detect AF during the examination. DSE was completely performed in 4,818 patients (mean age: 62.1 ± 11.7 years). AF was observed in 40 patients (31 men, mean age: 79.7 ± 8.9 years). Incidence of AF during DSE was 0.83%. Regarding the meta-analysis, the combined AF incidence was 0.86%. In our study, patients with AF occurrence had more frequent previous history of paroxysmal AF (p = 0.02) were also older (p < 0.0001) and incidence of AF during DSE increased with age: 0% below 60 years, 0.45% in patients 60 to 69 years, 1.3% in patients 70 to 79 years, and 4% in patients >80 years (p < 0.0001). In multivariate analysis, the factors significantly associated with an increased risk of AF were age (adjusted odds ratio (aOR) = 2.4, 95% confidence interval: 1.5 to 3.3, p = 0.003) and previous history of paroxysmal AF (aOR = 1.5, 95% confidence interval: 1.1 to 1.9; p = 0.04). In conclusion, AF is uncommon during DSE, and elderly patients and patients with previous history of paroxysmal AF are at risk of AF during DSE.
Prevalence and Potential Mechanisms of Sustained Ventricular Arrhythmias During Dobutamine Stress Echocardiography: A Literature Review
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In 10 studies;1,9,24-28,36,38,39 exercise or dipyridamole echocardiography stress studies had also been performed. According to published data1,3-40 (Tables 1 and 2); sustained ventricular arrhythmia occurred in 135 cases of 95;735 DSE studies (0.14%); with an event rate range of 0% to 2.1%. It is noticeable that DSE-induced sustained ventricular arrhythmias led to death in only 2 cases.1
Sustained ventricular tachycardia during dobutamine stress echocardiography is a rare complication of dobutamine stress echocardiography. It may be related to reduced left ventricular function and prior myocardial infarction but cannot be used as a sensitive or specific sign for myocardial ischemia. The clinical significance of dobutamine stress echocardiography-induced sustained ventricular tachycardia is uncertain, and this condition probably does not represent an adverse prognostic sign.
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Left atrial volume indexed (LAVI) has been reported as a predictor of cardiovascular events. We sought to determine the prognostic value of LAVI for predicting the outcome of patients who underwent dobutamine stress echocardiography (DSE) for known or suspected coronary artery disease (CAD).
From January 2000 to July 2005, we studied 981 patients who underwent DSE and off-line measurements of LAVI. The value of DSE over clinical and LAVI data was examined using a stepwise log-rank test.
During a median follow-up of 24 months, 56 (6%) events occurred. By univariate analysis, predictors of events were male sex, diabetes mellitus, previous myocardial infarction, left ventricular ejection fraction (LVEF), left atrial diameter indexed, LAVI, and abnormal DSE. By multivariate analysis, independent predictors were LVEF (relative risk [RR] = 0.98, 95% CI 0.95-1.00), LAVI (RR = 1.04, 95% CI 1.02-1.05), and abnormal DSE (RR = 2.70, 95% CI 1.28-5.69). In an incremental multivariate model, LAVI was additional to clinical data for predicting events (χ² 36.8, P < .001). The addition of DSE to clinical and LAVI yielded incremental information (χ² 55.3, P < .001). The 3-year event-free survival in patients with normal DSE and LAVI ≤33 mL/m² was 96%; with abnormal DSE and LAVI ≤33 mL/m², 91%; with normal DSE and LAVI >34 mL/m², 83%; and with abnormal DSE and LAVI >34 mL/m², 51%.
Left atrial volume indexed provides independent prognostic information in patients who underwent DSE for known or suspected CAD. Among patients with normal DSE, those with larger LAVI had worse outcome, and among patients with abnormal DSE, LAVI was still predictive.
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Original articleSafety and feasibility of dobutamine-atrophine stress echocardiography in patients with ischemic left ventricular dysfunction☆

Abstract

Am J Cardiol

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

Am J Cardiol

Lancet

Am J Cardiol

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

Original article
Safety and feasibility of dobutamine-atrophine stress echocardiography in patients with ischemic left ventricular dysfunction☆