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Background Dobutamine stress echocardiography (DSE) is an important tool in the diagnosis of coronary artery disease. However, there is hesitation in clinical practice for using it in patients with Chagas disease (CD) due to the arrhythmogenic potential of this heart condition. This study aimed to evaluate the incidence and variables associated with arrhythmias during DSE in a population of patients with CD. Methods A population of 205 consecutive patients with CD and suspected coronary heart disease was assessed through a retrospective database analysis. CD was confirmed in all patients by serological testing. Results The mean age of the patients selected was 64 years, and 65.4% of the patients were female. Significant arrhythmias occurred as follows: nonsustained ventricular tachycardia in 7.3% of patients; supraventricular tachycardia and sustained ventricular tachycardia in 1%; and atrial fibrillation in 0.5%. Nonsignificant arrhythmias occurred as follows: premature ventricular contractions in 48% of patients and bigeminy in 4.4%. Values for the wall‐motion score index at rest greater than 1.12 and 1.18 were independently correlated with the occurrence of nonsignificant arrhythmias (odds ratio [OR] = 2.90, P < 0.001) and significant arrhythmias (OR = 4.23, P = 0.044), respectively. Conclusion DSE should be considered a safe examination in patients with CD despite the known increased risk of arrhythmias in this group of patients. The occurrence of arrhythmias was low in this study. Abnormal wall‐motion score index values at rest were associated with the occurrence of significant and nonsignificant arrhythmias during the test.

BackgroundA few decades ago, patients with Chagas disease were predominantly rural workers, with a low risk profile for obstructive coronary artery disease (CAD). As urbanization has increased, they became exposed to the same risk factors for CAD of uninfected individuals. Dobutamine stress echocardiography (DSE) has proven to be an important tool in CAD diagnosis. Despite being a potentially arrhythmogenic method, it is safe for coronary patients without Chagas disease. For Chagas disease patients, however, the indication of DSE in clinical practice is uncertain, because of the arrhythmogenic potential of that heart disease.ObjectivesTo assess DSE safety in Chagas disease patients with clinical suspicion of CAD, as well as the incidence of arrhythmias and adverse events during the exam.MethodsRetrospective analysis of a database of patients referred for DSE from May/2012 to February/2015. This study assessed 205 consecutive patients with Chagas disease suspected of having CAD. All of them had their serology for Chagas disease confirmed.ResultsTheir mean age was 64±10 years and most patients were females (65.4%). No patient had significant adverse events, such as acute myocardial infarction, ventricular fibrillation, asystole, stroke, cardiac rupture and death. Regarding arrhythmias, ventricular extrasystoles occurred in 48% of patients, and non-sustained ventricular tachycardia in 7.3%.ConclusionDSE proved to be safe in this population of Chagas disease patients, in which no potentially life-threatening outcome was found.

Fundamento: Em 2007, a Food and Drug Administration (FDA) determinou revisões sobre segurança dos agentes de contraste ecocardiográfico (ACE) disponíveis no mercado após relatos de mortes. Ao longo desses anos, diversos estudos comprovaram a segurança dos ACE, porém com poucos estudos relacionados ao SonoVue ® . Objetivos: Avaliar a segurança do SonoVue ® durante o ecocardiograma sob estresse farmacológico (EEF) por meio da análise da incidência de reações alérgicas e da comparação entre os grupos quanto ao surgimento de arritmia, efeitos colaterais menores e eventos adversos. Métodos: Estudo observacional, prospectivo, no qual 2.346 pacientes foram submetidos ao EEF e divididos em dois grupos: grupo 1 com ACE (n=1.099) e grupo 2 sem ACE (n=1.247). Os pacientes foram avaliados durante o EEF -24 horas e 30 dias. Foi definido p significativo quando <0,05. Resultados: O grupo 1 apresentou efeitos colaterais mais leves, como cefaleia (5/0,5% vs. 19/1,5%, p=0,012) e hipertensão reativa (3/0,3% vs. 19/1,5%, p=0,002), menos arritmias como extrassístoles ventriculares (180/16,4% vs. 247/19,8%, p=0,032) e taquicardia paroxística supraventricular (2/0,2% vs. 15/1,2%, p=0,003), assim como nenhum evento adverso como infarto agudo do miocárdio (IAM) e óbito. No grupo 2, um paciente apresentou IAM <24h (1/01%) e dois óbitos <30 dias (2/0,1%). Urticária relacionada ao SonoVue ® foi observada em 3 (0,3%) pacientes sem reação anafilática. Conclusão: SonoVue ® demonstrou segurança durante o EEF, não sendo observados morte, IAM ou reação anafilática. Observou-se menor incidência de efeitos colaterais mais leves e arritmias no grupo que utilizou o ACE, assim como baixa incidência de reações alérgicas leves.

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