Pezzano A, Gentile F, Mantero A, Morabito A, Ravizza P
Dipartimento Cardiologico, A. De Gasperis Ospedale Ca' Granda-Niguarda, Milano.
G Ital Cardiol. 1998 Feb;28(2):102-11.
The aim of the study was to report the incidence and clinical meaning of side-effects caused by echo-dobutamine testing in a large population and to evaluate any possible correlation between dobutamine dose and side-effects.
The study population consisted of 3041 patients enrolled from January 1994 to August 1995 at 63 centers participating in the Italian Register of Echo-Dobutamine Testing (Registro Italiano Test Eco-Dobutamina, RITED). The four major indications were myocardial infarction older than one month (40.4%), recent myocardial infarction (22.7%), coronary artery disease without a history of myocardial infarction (10.8%) and suspected coronary artery disease (19.3%). Dobutamine was administered in a peripheral vein at 5, 10, 20, 30, 40 micrograms/kg/minute + atropine 1 mg in four divided doses of 0.25 mg/minute.
Severe complications were asystole, which went as high as 6" in one patient, and ventricular fibrillation in two patients. The clinical side-effects were headache (2.5%), hypotension (2.2%), nausea (1.7%), bradycardia (1.4%), palpitations (0.5%), tremors (0.3%), dyspnea (0.2%), paresthesia (0.2%) and hypertension (0.2%). Atrial arrhythmia was recorded in 10.6% of patients, while ventricular arrhythmia was recorded in 26.5%. The percentage of supraventricular and ventricular repetitive arrhythmia did not increase with dosage. The cumulative incidence of supraventricular and ventricular repetitive arrhythmia, considered as an interruption criteria, was 6.6% and 5.9%, respectively.
Echo-dobutamine stress test seems to be a very safe and reliable test for unmasking myocardial ischemia or viability in known or suspected coronary artery disease. It has been shown to be widely applicable in clinical practice for outpatients as well, as long as a protected environment is available.
