Vakalis Konstantinos, Berrill Max, Jimeno Majimen, Chester Ruth, Rahman-Haley Shelley, Barron Anthony, Baltabaeva Aigul
Department of Echocardiography, Harefield Hospital, Royal Brompton and Harefield Hospitals (part of Guy's and St Thomas' NHS Foundation Trust), Hill End Rd, Harefield, Uxbridge UB9 6JH, UK.
Eur Heart J Imaging Methods Pract. 2024 May 7;2(1):qyae038. doi: 10.1093/ehjimp/qyae038. eCollection 2024 Jan.
Myocardial response to stress echocardiography may be elicited physiologically, through exercise, or pharmacologically, often with dobutamine. Both have advantages but also limitations due to reduced exercise capacity or side-effects to stressor agent/lack of closeness to true pathophysiology of ischaemic cascade. We have combined low-dose dobutamine and exercise, creating a 'hybrid' protocol to utilize the advantages of both techniques and limit the drawbacks. The aim of the study was to evaluate its safety and feasibility.
In the hybrid protocol, low-dose dobutamine infusion (up to 10 µg/kg/min) is enhanced by supine bicycle exercise at 3-min increments of workload of 25 W to achieve target heart rate (THR). We analysed safety and outcome data for all the patients who underwent this protocol from 2017 to 2022. Out of 835, 727 (87.1%) patients referred for evaluation of ischaemia underwent the hybrid protocol. The median age was 61 years old and 61% (442/727) were men. The median exercise time was 11 (9-13.5) min with a median maximum workload of 100 W (75-125). Out of 727, 670 (92.2%) achieved THR. Atropine was not used. Out of 727, 192 (26.4%) of studies were positive for ischaemia. Out of 122, 102 (83.6%) with positive stress who underwent invasive angiography had significant coronary disease. The incidence of complications was low: 1/727-severe arrhythmia, 5/727 (0.7%) developed a vasovagal episode, and 14/727 (1.9%) had a hypertensive response to exercise.
Our findings suggest that this protocol is safe, feasible, and has a high success rate in achieving THR.
心肌对应激超声心动图的反应可通过运动在生理上诱发，或通过药物（通常使用多巴酚丁胺）诱发。两者都有优点，但也有局限性，原因是运动能力下降或应激剂的副作用/与缺血级联反应的真正病理生理学缺乏紧密联系。我们将小剂量多巴酚丁胺和运动相结合，创建了一种“混合”方案，以利用两种技术的优点并限制缺点。本研究的目的是评估其安全性和可行性。
在混合方案中，通过仰卧位骑自行车运动，以25W的工作量递增3分钟来增强小剂量多巴酚丁胺输注（最高10μg/kg/分钟），以达到目标心率（THR）。我们分析了2017年至2022年接受该方案的所有患者的安全性和结果数据。在835例中，727例（87.1%）因缺血评估而转诊的患者接受了混合方案。中位年龄为61岁，61%（442/727）为男性。中位运动时间为11（9 - 13.5）分钟，中位最大工作量为100W（75 - 125）。在727例中，670例（92.2%）达到了THR。未使用阿托品。在727例中，192例（26.4%）的检查结果为缺血阳性。在122例应激阳性且接受有创血管造影的患者中，102例（83.6%）患有严重冠状动脉疾病。并发症发生率较低：1/727 - 严重心律失常，5/727（0.7%）发生血管迷走神经发作，14/727（1.9%）对运动有高血压反应。
我们的研究结果表明，该方案是安全、可行的，并且在达到THR方面成功率很高。
