title: Accelerated dobutamine stress testing: safety and feasibility in patients with known or suspected coronary artery disease.
abstract: BACKGROUND
  Dobutamine pharmodynamics require approximately 10 min to reach steady state. Despite this, standard dobutamine stress echo typically uses 3-min stages of advancing dobutamine doses because of safety concerns.
  
  
  OBJECTIVE
  In patients with a high pretest probability of coronary artery disease (CAD), a continuous infusion of high-dose dobutamine is a feasible and safe method for performing a dobutamine stress test.
  
  
  METHODS
  Forty-seven consecutive patients (mean age 64 +/- 11 years) with 3.0 +/- 1.4 cardiac risk factors underwent dobutamine stress testing utilizing a single, high-dose (40 mcg/kg/min), continuous dobutamine infusion. The 40 mcg/kg/min infusion was continued for up to 10 min or until a test endpoint had been reached. If a test endpoint was not achieved, atropine (up to 1.0 mg) was added.
  
  
  RESULTS
  Heart rate rose from 71 +/- 12 to 137 +/- 18 beats/min at peak (p<0.0001) with a concomitant change in systolic blood pressure (143 +/- 35 vs. 167 +/- 38 mmHg; p = 0.001) but no change in diastolic blood pressure (74 +/- 19 vs. 75 +/- 18 mmHg; p = NS). Target heart rate was achieved in 20 of 47 (43%) patients with accelerated dobutamine alone and in 34 of 47 (72%) with the addition of atropine. An average of 11.6 +/- 3.7 min was required to obtain target heart rate. Subjective sensations from the dobutamine occurred in 49% of patients (palpitations 21%, nausea 6%, chest pain 6%, headache 6%, dizziness 13%), mild arrhythmia in 48% of patients (ventricular premature beats 38%, supraventricular tachycardia 10%), and one patient had nonsustained ventricular tachycardia.
  
  
  CONCLUSIONS
  A single, high-dose (40 mcg/kg/min) dobutamine-atropine protocol provides an efficient means of performing dobutamine stress echocardiography with a similar symptom profile as conventional dobutamine infusion protocols in patients with a high pretest probability of CAD. Randomized, controlled studies will be necessary to assess the sensitivity and specificity of this accelerated dobutamine echo protocol.
authors.affiliation: Washington V.A. Medical Center, DC, USA.
authors.forename: D
authors.initials: D
authors.lastname: Lu
authors.forename: M D
authors.initials: MD
authors.lastname: Greenberg
authors.forename: R
authors.initials: R
authors.lastname: Little
authors.forename: Q
authors.initials: Q
authors.lastname: Malik
authors.forename: D J
authors.initials: DJ
authors.lastname: Fernicola
authors.forename: N J
authors.initials: NJ
authors.lastname: Weissman
mesh_terms: D000368:Aged; D003327:Coronary Disease / Q000175:diagnosis*; D004280:Dobutamine / Q000008:administration & dosage* / Q000009:adverse effects; D004452:Echocardiography; D005080:Exercise Test / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D004280:Dobutamine