DOES HYPOTENSION DURING DOBUTAMINE STRESS ECHOCARDIOGRAPHY CORRELATE WITH ANATOMIC OR FUNCTIONAL CARDIAC IMPAIRMENT

The development of hypotension during various exercise stress tests ha s been correlated with the presence of multivessel coronary artery dis ease and impaired left ventricular contractility, Hypotension may also occur during dobutamine stress echocardiography; however, its anatomi c and functional significance remains unknown, As part of an ongoing s tudy of restenosis, dobutamine stress echocardiography and diagnostic cardiac catheterization were performed on the same day in 105 outpatie nts approximately 6 months after percutaneous coronary revascularizati on (balloon angioplasty or directional coronary atherectomy) to determ ine the anatomic and functional significance Of dobutamine-induced hyp otension, Dobutamine was infused in stepwise increments to a maximum r ate of 30 mu g/kg/min. Hypotension was defined as a reduction in systo lic blood pressure of greater than or equal to 15 mm Hg, Anatomic abno rmalities were defined by quantitative coronary angiography and functi onal abnormalities by digitized two-dimensional stress echocardiograph y. Clinical, angiographic, hemodynamic, and electrocardiographic data underwent multivariable regression analysis to determine their ability to predict independently the development of dobutamine-induced hypote nsion, Dobutamine-induced hypotension was not associated with the pres ence or severity of coronary artery disease or with echocardiographic wall motion abnormalities, Univariable predictors of stress-induced hy potension included high baseline systolic blood pressure, advanced age , and high left ventricular ejection fraction, Only a high baseline sy stolic blood pressure contributed independent predictive information i n multivariable stepwise logistic regression analysis, Therefore, the development of hypotension during dobutamine stress echocardiography, unlike that during traditional exercise stress tests, is not associate d with the presence of significant coronary artery disease or left ven tricular dysfunction.