[Complications of stress echocardiography].

BACKGROUND

Stress echocardiography is an established clinical testing method and is accurate for the detection of coronary artery disease. Despite its widespread use, the safety of stress echocardiography has not been sufficiently documented in Japanese laboratories.

OBJECTIVES

The feasibility, safety, complications and side effects of stress echocardiography were assessed for detecting myocardial ischemia in patients with suspected coronary artery disease.

METHODS

1,866 patients who underwent dobutamine echocardiography(n = 897), exercise echocardiography(n = 722), and dipyridamole echocardiography(n = 247) were prospectively studied from November 1990 to April 2000. Dobutamine was administered intravenously at 5, 10, 20, 30, 40 micrograms/kg/min in 3-minute intervals. Exercise echocardiography used the supine ergometer, starting at 50 W and increasing gradually by 25 W at 3-minute intervals to the maximum of 150 W. Dipyridamole was administered intravenously at 0.14 mg/kg/min for 4 min. After a 4-minute observation period, the drug was re-administered at the same dose for 2 min.

RESULTS

The most common side effects under each stress were ventricular premature beats in 34.1% (dobutamine echocardiography), ventricular premature beats in 14.4%(exercise), and headache in 24.3% (dipyridamole). Serious side effects occurred in one patient(0.05%). The case of acute myocardial infarction was caused by dipyridamole echocardiography, and the patient needed emergency coronary angioplasty. Seven patients needed other drug therapy for nonsustained ventricular tachycardia(one), paroxysmal supraventricular tachycardia(two), sinus bradycardia(three), and bronchial asthma(one). There was no incidence of death, shock, or ventricular fibrillation, sustained ventricular tachycardia or other conditions requiring inpatient observation during stress echocardiography.

CONCLUSIONS

Stress echocardiography is a reasonable, safe method for determining myocardial ischemia, but may be associated with minor, self-limiting side effects.