dic Arquivos Brasileiros de Cardiologia Imagem cardiovascular Arq Bras Cardiol: Imagem cardiovasc 2675-312X Sociedade Brasileira de Cardiologia eabc110 10.47593/2675-312X/20203304eabc110 Original Article Analysis of the Safety and Feasibility of Dobutamine Stress Echocardiography in Ten Thousand and Six Tests of a General Population Análise da Segurança e Exequibilidade do Ecocardiograma sob Estresse com Dobutamina em Dez Mil e Seis Exames de uma População Geral Abreu José Sebastião de 1 2 Pinheiro Tereza Cristina Diógenes 1 2 Abreu Marília Esther Benevides de 1 2 Farias Ana Gardenia Liberato Ponte 2 3 Carneiro Marcia Maria 2 3 Clinicárdio Diagnostic Methods Fortaleza CE Clinicárdio Diagnostic Methods, Fortaleza, CE; Cardioexata of Fortaleza CE Cardioexata of Fortaleza, CE; Clinical Hospital Federal University of Ceará CE Brazil Clinical Hospital, Federal University of Ceará, CE, Brazil. Mailing Address: José Sebastião de Abreu • Rua Dr. José Lourenço, 500, apto. 700 – Meireles – CEP: 60115-280 – Fortaleza, CE, Brazil. E-mail: jsabreu@cardiol.br ; jsabreu10@yahoo.com.br

Authors’ contributions

Research creation and design: Abreu JS. Data acquisition: Abreu JS, Pinheiro TCD, Farias AGLP. Data analysis and interpretation: Abreu JS, Pinheiro TCD, Abreu MEB. Statist ical an a lysis: Abreu JS. Manuscript writing: Abreu JS, Abreu MEB, Carneiro MM. Critical revision of the manuscript for important intellectual content: Abreu JS, Farias AGLP, Carneiro MM.

Conflict of interest

The authors have declared that they have no conflict of interest.

 17 12 2021 Oct-Dec 2020 33 4 1 8 11 5 2020 15 6 2020 22 6 2020 This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 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.

 Resumo Fundamento

Durante o ecocardiograma sob estresse com dobutamina, podem ocorrer efeitos adversos e exames inconclusivos.

 Objetivo

Avaliar em uma grande população geral a segurança e a exequibilidade do ecocardiograma sob estresse com dobutamina.

 Métodos

Estudo de 10.006 ecocardiogramas sob estresse com dobutamina realizados no período de julho de 1996 a setembro de 2007. A dobutamina foi administrada em quatro estágios (10, 20, 30 e 40 μcg.kg-1.min-1) para pesquisa de isquemia miocárdica e iniciada com 5 μcg.kg-1.min-1 apenas na análise de viabilidade miocárdica. A atropina foi iniciada conforme os protocolos vigentes. Foram verificados dados clínicos, hemodinâmicos e efeitos adversos associados ao ecocardiograma sob estresse com dobutamina.

 Resultados

Durante os ecocardiogramas sob estresse com dobutamina, ocorreu angina típica (8,9%), pico hipertensivo (1,7%), ectopias ventriculares isoladas (31%), taquiarritmia supraventricular (1,89%), fibrilação atrial (0,76%) e taquicardia ventricular não sustentada (0,6%). Os efeitos adversos citados foram mais frequentes nos pacientes com ecocardiogramas sob estresse com dobutamina positivos para isquemia. A desaceleração sinusal paradoxal (0,16%) não ocorreu em ecocardiogramas sob estresse com dobutamina positivo. As três complicações graves ocorreram em ecocardiogramas sob estresse com dobutamina positivos para isquemia. Foram dois casos (0,02%) com FV e um caso de síndrome coronariana aguda (0,01%). Não houve caso de taquicardia ventricular sustentada, ruptura cardíaca, assistolia ou óbito. Comparados aos exames concluídos, nos inconclusivos, os pacientes usaram menos atropina (81,5% versus 49,9%; p< 0,001) e mais betabloqueador (4,7% versus 19%; p< 0,001), apresentando mais pico hipertensivo (1,1% versus 14,2%; p = 0,0001) e taquicardia ventricular não sustentada (0,5% versus 2,2%; p< 0,001).

 Conclusão

O ecocardiograma sob estresse com dobutamina realizado de forma apropriada é seguro e apresenta elevada exequibilidade.

 Dobutamine Side Effects Echocardiography, Stress Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos Ecocardiografia sob Estresse Dobutamina