SYMPTOMS, ADVERSE-EFFECTS, AND COMPLICATIONS ASSOCIATED WITH DOBUTAMINE STRESS ECHOCARDIOGRAPHY - EXPERIENCE IN 1118 PATIENTS

Background. The use of dobutamine stress echocardiography for the eval uation of coronary artery disease is rapidly expanding. New applicatio ns of the technique are being investigated in a wide variety of patien ts including those with advanced coronary artery disease. Despite its widespread use, the safety of dobutamine stress echocardiography has n ot been sufficiently documented. Methods and Results. A consecutive se ries of 1118 patients undergoing dobutamine stress echocardiography fo r evaluation of known or suspected coronary artery disease form the ba sis of this report. Dobutamine stress testing was performed for evalua tion of chest pain, risk assessment before noncardiac surgery, after r ecent myocardial infarction, or as a part of ongoing research protocol s. Over the study period, the maximal dose of dobutamine used was incr eased from 30 to 50 mug/kg per minute, and atropine was used in 420 (3 7%) patients. There were no occurrences of death, myocardial infarctio n, or episodes of sustained ventricular tachycardia as a result of dob utamine stress testing. The major reasons for test termination were ac hievement of target heart rate in 583 patients (52.1%), maximum dose i n 255 (22.8%), and angina pectoris in 142 (13%). The test was terminat ed in 36 (3%) patients because of noncardiac side effects including na usea, anxiety, headache, tremor, and urgency. Angina pectoris occurred in 216 (19.3%) patients. Sublingual nitroglycerin, a short-acting bet a-blocker, or both types of medication were administered in 80 of thes e patients for relief of angina pectoris. None required intravenous ni troglycerin. A total of 736 (65%) patients had stable sinus rhythm thr oughout the test. The most common arrhythmias were frequent premature ventricular complexes (six or more per minute) in 172 patients (15%), and frequent premature atrial complexes in 86 (8%). There were 40 pati ents with nonsustained ventricular tachycardia. None had symptoms asso ciated with the tachycardia, and only one received specific pharmacolo gical treatment to prevent recurrence of the arrhythmia after the test was terminated. The patients who were evaluated after recent myocardi al infarction and those who received atropine did not have a higher fr equency of ventricular tachycardia compared with those without recent infarction and those not receiving atropine. Conclusions. Dobutamine s tress echocardiography was safely performed using supplemental atropin e and an aggressive dosing protocol. Noncardiac side effects were usua lly minor. Arrhythmias were well tolerated and rarely required treatme nt. In this study, serious complications from myocardial ischemia did not occur. Symptomatic ischemia was effectively treated with test term ination, sublingual nitroglycerin, or short-acting beta-blockers.