José Sebastião de Abreu et al. Tereza Cristina Diógenes Pinheiro Marília Esther Benevides de Abreu Ana Gardenia Liberato Ponte Farias Marcia Maria Carneiro
Abstract
Background
Adverse effects and inconclusive results may occur on dobutamine stress echocardiography.
Objective
To assess the safety and feasibility of dobutamine stress echocardiography in a large general population.
Methods
A total of 10,006 dobutamine stress echocardiographies were performed between July 1996 and September 2007. Dobutamine was administered in four stages (10, 20, 30, and 40 μcg·kg-1·min-1) to research myocardial ischemia starting with 5 μcg·kg-1·min-1 to analyze myocardial viability. Atropine was started according to the protocols used in the period. Clinical, hemodynamic, and adverse effect data associated with dobutamine stress echocardiography findings were verified.
Results
Typical angina (8.9%), hypertensive peak (1.7%), isolated ventricular ectopias (31%), supraventricular tachyarrhythmia (1.89%), atrial fibrillation (0.76%), and non-sustained ventricular tachycardia (0.6%) occurred during dobutamine stress echocardiography. The adverse effects occurred more frequently in patients with positive dobutamine stress echocardiography findings for ischemia than in those with negative findings. Paradoxical sinus deceleration (0.16%) did not occur in cases of positive dobutamine stress echocardiography findings. Three severe complications occurred in cases that tested positive for ischemia on dobutamine stress echocardiography: two (0.02%) of ventricular fibrillation and one of acute coronary syndrome (0.01%). There were no cases of sustained ventricular tachycardia, cardiac rupture, asystole, or death. Compared to those with complete tests, patients with inconclusive results used less atropine (81.5% versus 49.9%, p < 0.001) and more beta-blockers (4.7% versus 19%, p < 0.001) and more commonly presented with a hypertensive peak (1.1% versus 14.2%, p = 0.0001) or non-sustained ventricular tachycardia (0.5% versus 2.2%, p < 0.001).
Conclusion
When properly performed, dobutamine stress echocardiography is safe and has high feasibility.