Chauvel C, Cohen A, Khireddine M
Cardiology Department, Saint-Antoine University Hospital and Medical School, Paris, France.
Eur Heart J. 1996 Dec;17(12):1898-901. doi: 10.1093/oxfordjournals.eurheartj.a014809.
Dobutamine-atropine stress echocardiography is an efficient method in the evaluation of patients with coronary artery disease. However, because high-dose dobutamine is potentially arrhythmogenic, the safety of this stress modality has been questioned.
We performed a 24 h Holter monitoring, before and immediately after this test, in 73 consecutive patients (60 men and 13 women), mean age 60 +/- 12 years. Twenty-eight patients had had a recent myocardial infarction, 25 had stable chronic angina, 10 chronic ischaemic cardiomyopathy and 10 idiopathic dilated cardiomyopathy. Dobutamine was progressively increased (5-40 micrograms.kg-1.min-1) and atropine was injected in 30 patients. Arrhythmias and ST-segment deviation before and after the stress test were evaluated.
The mean peak dobutamine dose was 32 +/- 11 micrograms.kg-1.min-1. The heart rate at rest and at peak dose was, respectively, 69 +/- 16 and 110 +/- 28 beats.min-1. Side effects during the injection of dobutamine were mainly ventricular (n = 14) or atrial (n = 4) premature contractions. Three patients had non-sustained ventricular tachycardia and five had hypotension during the test. No sustained episode of supraventricular or ventricular tachycardia was observed during the study. Non-sustained supraventricular and ventricular tachycardias were detected in 8 and 21 patients before and in 11 and 16 patients after dobutamine stress echocardiography (P = ns). Asymptomatic ST-segment deviation was observed in two patients before and four after dobutamine stress echocardiography. An increase in total ischaemic time (20 vs 102 mn) was observed after the test, but only five patients had ST modifications. A separate analysis of patients with and without beta-blocker did not alter these results. In addition, when the occurrence of significant arrhythmias was stratified according to a left ventricular ejection fraction threshold of 45%, we observed no difference in frequency and severity of cardiac arrhythmias.
This study demonstrates that dobutamine stress echocardiography does not significantly increase arrhythmia during the following 24 h. Further studies are required to evaluate the influence of the test on ST-segment modification during the same period.
多巴酚丁胺 - 阿托品负荷超声心动图是评估冠心病患者的一种有效方法。然而，由于高剂量多巴酚丁胺可能诱发心律失常，这种负荷检查方式的安全性受到质疑。
我们对73例连续患者（60例男性和13例女性）在该项检查前及检查后立即进行了24小时动态心电图监测，患者平均年龄为60±12岁。28例患者近期发生过心肌梗死，25例患有稳定型慢性心绞痛，10例患有慢性缺血性心肌病，10例患有特发性扩张型心肌病。多巴酚丁胺剂量逐渐增加（5 - 40微克·千克⁻¹·分钟⁻¹），30例患者注射了阿托品。评估了负荷试验前后的心律失常和ST段偏移情况。
多巴酚丁胺的平均峰值剂量为32±11微克·千克⁻¹·分钟⁻¹。静息时及峰值剂量时的心率分别为69±16次/分钟和110±28次/分钟。多巴酚丁胺注射期间的副作用主要为室性（n = 14）或房性（n = 4）早搏。3例患者在检查期间发生非持续性室性心动过速，5例出现低血压。研究期间未观察到持续性室上性或室性心动过速发作。多巴酚丁胺负荷超声心动图检查前，8例患者检测到非持续性室上性心动过速，21例检测到非持续性室性心动过速；检查后，11例患者检测到非持续性室上性心动过速，16例检测到非持续性室性心动过速（P = 无统计学意义）。多巴酚丁胺负荷超声心动图检查前，2例患者观察到无症状ST段偏移；检查后，4例患者观察到无症状ST段偏移。检查后观察到总缺血时间增加（20分钟对102分钟），但只有5例患者出现ST段改变。对使用和未使用β受体阻滞剂的患者进行单独分析，并未改变这些结果。此外，当根据左心室射血分数阈值45%对显著心律失常的发生情况进行分层时，我们观察到心律失常的频率和严重程度没有差异。
本研究表明，多巴酚丁胺负荷超声心动图在随后24小时内不会显著增加心律失常的发生。需要进一步研究来评估该检查在同一时期对ST段改变的影响。
