Complications of pharmacologic stress echocardiography in coronary artery disease.
In the last few years, pharmacologic stress echocardiography is emerging as a promising diagnostic tool with a favorable cost/benefit ratio. Its main clinical applications include the assessment of coronary artery disease, the identification of viable myocardium, and risk stratification before major vascular surgery. However, cardiac (arrhythmic, ischemic, or hemodynamic) as well as noncardiac complications have been reported, so that a risk/benefit analysis is advisable in view of the extensive introduction of this technique in the clinical arena. The most popular pharmacologic agents employed for stress echocardiography are dipyridamole, dobutamine, and adenosine. A comparative analysis with exercise stress testing, the classical standard a reference of all ischemia-provoking tests, confirms that in terms of safety and tolerability pharmacologic stress echocardiography may be considered a good alternative in patients unable to exercise maximally. No appreciable difference among the safety profiles of the most common pharmacologic agents has been found, but a careful evaluation of the risk/benefit ratio is advisable for any stressor in the individual patient by considering the relative importance of the expected diagnostic contribution and the pharmacodynamic impact of the test. Finally, adequate training of the operator and monitoring of the patient during stress and recovery are essential for getting optimal safety conditions.
Bigi
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Division of Cardiac Rehabilitation, Regional Hospital, Sondalo, Italy.
D000241:Adenosine / Q000009:adverse effects; D002316:Cardiotonic Agents / Q000009:adverse effects; D002317:Cardiovascular Agents / Q000009:adverse effects; D003327:Coronary Disease / Q000175:diagnosis / Q000000981:diagnostic imaging*; D004176:Dipyridamole / Q000009:adverse effects; D004280:Dobutamine / Q000009:adverse effects; D004452:Echocardiography / Q000009:adverse effects / Q000379:methods; D005080:Exercise Test / Q000009:adverse effects*; D006801:Humans; D014665:Vasodilator Agents / Q000009:adverse effects
D002316:Cardiotonic Agents; D002317:Cardiovascular Agents; D014665:Vasodilator Agents; D004280:Dobutamine; D004176:Dipyridamole; D000241:Adenosine