Tolerance, hemodynamic changes, and safety of dobutamine stress perfusion imaging.
BACKGROUND
Dobutamine myocardial perfusion imaging is being used increasingly for assessment of coronary artery disease. Heretofore, there have been no large series documenting its tolerance and safety. The aims of this study were to assess the tolerance, hemodynamic changes, and safety of dobutamine stress in conjunction with myocardial perfusion imaging.


RESULTS
The tolerance, hemodynamic changes, and safety of dobutamine myocardial perfusion imaging were investigated in a consecutive series of 1012 patients. Dobutamine was infused at incremental doses of 10, 20, 30, and 40 micrograms/kg/min at 3-minute intervals. Perfusion tomography was performed according to standard protocols with either 201Tl or 99mTc-labeled sestamibi. Seven hundred twenty-nine patients (72%) reached a maximal dobutamine dose of 40 micrograms/kg/min. Dobutamine significantly increased heart rate (76 +/- 14 beats/min to 127 +/- 20 beats/min; p < 0.001) and systolic blood pressure (141 +/- 20 mm Hg to 168 +/- 36 mm Hg; p < 0.001) from baseline to peak infusion rate. The most common side effects were chest pain (31%), headache (14%), dyspnea (12%), palpitations (10%), and flushing (10%). There was no death, myocardial infarction, pulmonary edema, ventricular fibrillation, sustained ventricular tachycardia, or cerebral vascular accident. Nonsustained ventricular tachycardia occurred in 43 patients (4.2%) but did not cause any hemodynamic instability.


CONCLUSIONS
When done with the necessary caution, dobutamine myocardial perfusion imaging is a safe diagnostic test, although side effects are common.
Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA.
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Dakik
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Verani
D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000139:chemically induced; D001145:Arrhythmias, Cardiac / Q000139:chemically induced; D001794:Blood Pressure / Q000187:drug effects; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000009:adverse effects; D015331:Cohort Studies; D003326:Coronary Circulation; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004280:Dobutamine / Q000008:administration & dosage / Q000009:adverse effects; D004361:Drug Tolerance; D004417:Dyspnea / Q000139:chemically induced; D005260:Female; D005483:Flushing / Q000139:chemically induced; D006261:Headache / Q000139:chemically induced; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D019275:Radiopharmaceuticals; D012449:Safety; D013312:Stress, Physiological / Q000503:physiopathology; D013599:Systole; D017180:Tachycardia, Ventricular / Q000139:chemically induced; D017256:Technetium Tc 99m Sestamibi; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods
D002316:Cardiotonic Agents; D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes; D004280:Dobutamine; D017256:Technetium Tc 99m Sestamibi