Dobutamine stress echocardiography for the detection of myocardial viability in patients with left ventricular dysfunction taking beta blockers: accuracy and optimal dose.
OBJECTIVE
To assess the accuracy of dobutamine stress echocardiography (DSE) and the optimal dose of dobutamine to detect myocardial viability in patients with ischaemic left ventricular (LV) dysfunction who are taking beta blockers, using the recovery of function six months artery revascularisation as the benchmark.


METHODS
17 patients with ischaemic LV dysfunction (ejection fraction < 40%) and chronic treatment with beta blockers scheduled to undergo surgical revascularisation.


METHODS
Regional cardiothoracic centre.


METHODS
All patients underwent DSE one week before and resting echocardiography six months after revascularisation. A wall motion score was assigned to each segment for each dobutamine infusion stage, using the standard 16 segment model of the left ventricle. The accuracy of DSE to predict recovery of resting segmental function was calculated for low dose (5 and 10 microg/kg/min) and for a full protocol of dobutamine infusion (5 to 40 microg/kg/min).


RESULTS
Of the 272 segments studied, 158 (58%) were dysfunctional at rest, of which 79 (50%) improved at DSE and 74 (47%) recovered resting function after revascularisation. Analysis of results with a low dose showed a significantly lower sensitivity and negative predictive value than with a full protocol (47% v 81%, p < 0.001 and 65% v 82%, p < 0.05, respectively). The accuracy in the full protocol analysis was comparable with that reported in patients no longer taking beta blockers but was significantly lower than that in the low dose analysis (78% v 66%, p < 0.001).


CONCLUSIONS
Findings suggest that beta blocker withdrawal is not necessary before DSE when viability is the clinical information in question. However, a completed protocol with continuous image recording is required to detect the full extent of viability.
Zaglavara
T
T
Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK.
Haaverstad
R
R
Cumberledge
B
B
Irvine
T
T
Karvounis
H
H
Parharidis
G
G
Louridas
G
G
Kenny
A
A
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D001262:Atenolol / Q000627:therapeutic use*; D002316:Cardiotonic Agents / Q000008:administration & dosage; D002908:Chronic Disease; D001026:Coronary Artery Bypass / Q000379:methods; D004280:Dobutamine / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D025401:Echocardiography, Stress / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000627:therapeutic use*; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis*; D009204:Myocardial Revascularization / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy*
D000319:Adrenergic beta-Antagonists; D002316:Cardiotonic Agents; D004280:Dobutamine; D001262:Atenolol; D008790:Metoprolol