Paradoxic hypotension during dobutamine stress echocardiography: clinical and diagnostic implications.
OBJECTIVE
The purpose of this study was to elucidate the prevalence, magnitude and clinical implications of a hypotensive response during dobutamine stress echocardiography.


BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Marcovitz
P A
PA
Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor.
Bach
D S
DS
Mathias
W
W
Shayna
V
V
Armstrong
W F
WF
D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004280:Dobutamine / Q000494:pharmacology*; D004452:Echocardiography; D005080:Exercise Test / Q000379:methods; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis
D004280:Dobutamine