Dobutamine Stress Echo Is Superior to Exercise Stress Testing in Achieving Target Heart Rate among Patients on Beta Blockers

Abstract

Published guidelines recommend continuing β-adrenergic receptor blockade in patients undergoing stress testing. We evaluated the role of pharmacological versus exercise stress testing in achieving target heart rate (THR) among patients on β-adrenergic blockade. We compared data from 140 patients who underwent dobutamine stress echo (DSE) and 143 patients who underwent exercise treadmill testing (ETT). In both groups, β-adrenergic blocker was continued at the time of stress testing. Overall, patients undergoing DSE achieved THR more frequently than ETT. With β-adrenergic blockade, DSE patients met THR more frequently than ETT patients (p < 0.001). Without β-adrenergic blockade, there was no difference between either modality in achieving THR. In both DSE and ETT patients, absence of β-adrenergic blockade increased the odds of achieving THR [odds ratio (OR): 2.46, p = 0.042 and OR: 7.44, p < 0.001, respectively]. Atropine use with DSE increased the odds of achieving THR (OR: 3.76, p = 0.006). In conclusion, pharmacological stress testing appears to be superior to exercise stress testing in achieving THR among patients on β-adrenergic blockade.

Utilizing DMAIC Six Sigma and Evidence-Based Medicine to Streamline Diagnosis in Chest Pain

“…[26][27][28][29] This is the point where the computer will track the results of these deviations and track the physician's results. After performing the 12-lead ECG, the clinician will enter the results, specifically those ST segments, read into the computer and from the database, the computer will evaluate a level of risk based on a combination of the 12-lead ECG, as well as the previously assessed risk factors.…”

Validation of VO2max Assessment and Magnetic Resonance Cardiac Function Measurements Utilizing an MRI Compatible Treadmill

“…Research suggests, there are reductions in cardiac function, such as ventricular muscle wall tension, peak systolic stress, and left ventricular volume measures associated with dobutamine and other pharmacological stress testing methods compared to exercise stress testing [14]. However, there are specific clinical populations in which pharmacological stress testing may be utilized preferentially; if patients are unable to safely complete exercise, or medications limit the effectiveness of exercise to produce physiological cardiac stress required [14,15]. Exercise places stress on the body that enhances clinical precision in identifying signs or symptoms of disease.…”