Marcovitz P A, Bach D S, Mathias W, Shayna V, Armstrong W F
Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor.
J Am Coll Cardiol. 1993 Apr;21(5):1080-6. doi: 10.1016/0735-1097(93)90228-s.
The purpose of this study was to elucidate the prevalence, magnitude and clinical implications of a hypotensive response during dobutamine stress echocardiography.
Dobutamine stress echocardiography is an accurate noninvasive method for detecting coronary artery disease. It has been associated with unexpected hypotension in a proportion of patients. Hypotension occurring during exercise testing has been associated with an increased prevalence of multivessel coronary artery disease and a poor prognosis. The clinical significance of hypotension when seen during dobutamine infusion for diagnostic testing is unknown.
Clinical characteristics, coronary artery anatomy (n = 41), ventricular function at rest and during dobutamine infusion and prognosis were evaluated in 115 patients experiencing hypotension during dobutamine stress echocardiography and compared with data in 59 nonhypotensive catheterized patients for comparison of coronary anatomy and in 239 nonhypotensive patients for prognostic purposes.
Hypotension occurred in 115 (20%) of 568 consecutive patients studied with dobutamine stress echocardiography. It was gradual in 73 and precipitous in 42 patients. There were no statistical differences among the hypotensive groups and the index group in prevalence or severity of coronary disease or in prognosis during 15 months compared with findings in nonhypotensive patients.
Hypotension occurs commonly during dobutamine stress echocardiography, and patients with dobutamine-induced hypotension constitute a heterogeneous group. Unlike hypotension occurring with exercise testing, dopamine-induced hypotension is not invariably associated with advanced coronary disease or an adverse prognosis.
本研究旨在阐明多巴酚丁胺负荷超声心动图检查期间低血压反应的发生率、程度及临床意义。
多巴酚丁胺负荷超声心动图是检测冠状动脉疾病的一种准确的非侵入性方法。在一部分患者中，它与意外的低血压有关。运动试验期间出现的低血压与多支冠状动脉疾病的患病率增加及预后不良有关。多巴酚丁胺输注用于诊断检查时出现低血压的临床意义尚不清楚。
对115例在多巴酚丁胺负荷超声心动图检查期间出现低血压的患者的临床特征、冠状动脉解剖结构（n = 41）、静息及多巴酚丁胺输注期间的心室功能和预后进行评估，并与59例非低血压的导管插入术患者的冠状动脉解剖数据以及239例非低血压患者的预后数据进行比较。
在连续接受多巴酚丁胺负荷超声心动图检查的568例患者中，115例（20%）出现低血压。73例患者的低血压是逐渐发生的，42例患者的低血压是突然发生的。与非低血压患者相比，低血压组和指标组在冠状动脉疾病的患病率或严重程度以及15个月期间的预后方面无统计学差异。
多巴酚丁胺负荷超声心动图检查期间低血压很常见，多巴酚丁胺诱发低血压的患者构成一个异质性群体。与运动试验时出现的低血压不同，多巴酚丁胺诱发的低血压并不总是与晚期冠状动脉疾病或不良预后相关。
