Lu D, Greenberg M D, Little R, Malik Q, Fernicola D J, Weissman N J
Washington V.A. Medical Center, DC, USA.
Clin Cardiol. 2001 Feb;24(2):141-5. doi: 10.1002/clc.4960240208.
Dobutamine pharmodynamics require approximately 10 min to reach steady state. Despite this, standard dobutamine stress echo typically uses 3-min stages of advancing dobutamine doses because of safety concerns.
In patients with a high pretest probability of coronary artery disease (CAD), a continuous infusion of high-dose dobutamine is a feasible and safe method for performing a dobutamine stress test.
Forty-seven consecutive patients (mean age 64 +/- 11 years) with 3.0 +/- 1.4 cardiac risk factors underwent dobutamine stress testing utilizing a single, high-dose (40 mcg/kg/min), continuous dobutamine infusion. The 40 mcg/kg/min infusion was continued for up to 10 min or until a test endpoint had been reached. If a test endpoint was not achieved, atropine (up to 1.0 mg) was added.
Heart rate rose from 71 +/- 12 to 137 +/- 18 beats/min at peak (p<0.0001) with a concomitant change in systolic blood pressure (143 +/- 35 vs. 167 +/- 38 mmHg; p = 0.001) but no change in diastolic blood pressure (74 +/- 19 vs. 75 +/- 18 mmHg; p = NS). Target heart rate was achieved in 20 of 47 (43%) patients with accelerated dobutamine alone and in 34 of 47 (72%) with the addition of atropine. An average of 11.6 +/- 3.7 min was required to obtain target heart rate. Subjective sensations from the dobutamine occurred in 49% of patients (palpitations 21%, nausea 6%, chest pain 6%, headache 6%, dizziness 13%), mild arrhythmia in 48% of patients (ventricular premature beats 38%, supraventricular tachycardia 10%), and one patient had nonsustained ventricular tachycardia.
A single, high-dose (40 mcg/kg/min) dobutamine-atropine protocol provides an efficient means of performing dobutamine stress echocardiography with a similar symptom profile as conventional dobutamine infusion protocols in patients with a high pretest probability of CAD. Randomized, controlled studies will be necessary to assess the sensitivity and specificity of this accelerated dobutamine echo protocol.
多巴酚丁胺药效学需要大约10分钟达到稳态。尽管如此，由于安全顾虑，标准多巴酚丁胺负荷超声心动图通常采用3分钟递增多巴酚丁胺剂量的阶段。
在冠状动脉疾病（CAD）预检概率高的患者中，持续输注高剂量多巴酚丁胺是进行多巴酚丁胺负荷试验的一种可行且安全的方法。
47例连续患者（平均年龄64±11岁），有3.0±1.4个心脏危险因素，采用单次高剂量（40微克/千克/分钟）持续多巴酚丁胺输注进行多巴酚丁胺负荷试验。40微克/千克/分钟的输注持续长达10分钟或直至达到试验终点。如果未达到试验终点，则加用阿托品（最大剂量1.0毫克）。
心率在峰值时从71±12次/分钟升至137±18次/分钟（p<0.0001），同时收缩压有变化（143±35与167±38毫米汞柱；p = 0.001），但舒张压无变化（74±19与75±18毫米汞柱；p = 无显著性差异）。47例患者中有20例（43%）仅用加速多巴酚丁胺达到目标心率，加用阿托品后47例中有34例（72%）达到目标心率。平均需要11.6±3.7分钟达到目标心率。49%的患者出现多巴酚丁胺引起的主观感觉（心悸21%、恶心6%、胸痛6%、头痛6%、头晕13%），48%的患者出现轻度心律失常（室性早搏38%、室上性心动过速10%），1例患者出现非持续性室性心动过速。
单一高剂量（每千克每分钟40微克）多巴酚丁胺 - 阿托品方案提供了一种有效的方法来进行多巴酚丁胺负荷超声心动图检查，在CAD预检概率高的患者中，其症状特征与传统多巴酚丁胺输注方案相似。需要进行随机对照研究来评估这种加速多巴酚丁胺超声心动图方案的敏感性和特异性。
