Safety of dobutamine stress real-time myocardial contrast echocardiography.
OBJECTIVE
The aim of this study was to determine the safety of dobutamine stress myocardial perfusion imaging (MPI) obtained by real-time contrast echocardiography (RTCE) and intravenous ultrasound contrast in a large cohort of patients with suspected coronary artery disease (CAD).


BACKGROUND
Despite the increasing number of studies showing the potential clinical utility of myocardial contrast perfusion imaging with commercially available contrast agents, the safety of this technique in a clinical setting has not been demonstrated.


METHODS
Over a four-year period, 1,486 patients underwent dobutamine stress RTCE with low mechanical index pulse sequence schemes after intravenous injections of commercially available contrast agents (35% Definity, Bristol Myers Squibb Medical Imaging Inc., North Billerica, Massachusetts; 65% Optison, GE-Amersham, Princeton, New Jersey). The hemodynamic and adverse effects of RTCE were compared with 1,012 patients who underwent conventional dobutamine stress echocardiography (DSE) without contrast. The feasibility of image analysis was defined as the ability to analyze MPI in at least two of the three standard segments in each left ventricular wall.


RESULTS
No myocardial infarction or death occurred during dobutamine stress. There was no difference in the incidence of nonsustained ventricular tachycardia, sustained ventricular tachycardia, or supraventricular tachycardia during dobutamine infusion between RTCE and DSE. Myocardial perfusion imaging was considered feasible for analysis in 94% of the walls at baseline and 95% at peak stress. The anterior, lateral, and posterior walls were the most common regions in which MPI was not feasible. Myocardial perfusion imaging with RTCE had a higher accuracy for detecting patients with angiographically significant CAD than the analysis of wall motion (84% vs. 66%, respectively; p < 0.001).


CONCLUSIONS
Dobutamine stress RTCE appears to be a safe and feasible technique for evaluating patients with known or suspected CAD.
Tsutsui
Jeane M
JM
Department of Internal Medicine, Section of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska 68198-1165, USA.
Elhendy
Abdou
A
Xie
Feng
F
O'Leary
Edward L
EL
McGrain
Anna C
AC
Porter
Thomas R
TR
D002316:Cardiotonic Agents; D015331:Cohort Studies; D003287:Contrast Media / Q000008:administration & dosage; D003326:Coronary Circulation / Q000502:physiology; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D004280:Dobutamine; D025401:Echocardiography, Stress / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D012449:Safety
D002316:Cardiotonic Agents; D003287:Contrast Media; D004280:Dobutamine