Hypotension during dobutamine stress echocardiography: Initial description and clinical relevance

Rosamond, Thomas; Vacek, James L.; Hurwitz, Aryeh; Rowland, A.Jody; Beauchamp, Gary D.; Crouse, Linda J.

doi:10.1016/0002-8703(92)90652-c

Cited by 61 publications

(10 citation statements)

References 21 publications

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“…This wide range is mainly due to the different definitions of hypotensive response used. Multiple studies used the drop in blood pressure from peak blood pressure throughout the DSE protocol [8,10], while other studies used the drop from base blood pressure [9,11] or a combination of end points [12,13]. Also, the cut-off point for hypotensive response in the various studies ranged from 0 to ≥ 50 mmHg.…”

Section: Main Findingsmentioning

confidence: 99%

“…A hypotensive response to exercise stress has been shown to correlate with severe coronary artery disease as well as poor cardiac prognosis [5][6][7]. Hypotensive response occurring during dobutamine stress testing appears to be more common, with an occurrence of 14-48% [8,9]. Moreover, a hypotensive response during dobutamine International Journal of Cardiology 125 (2008) 358 -363 www.elsevier.com/locate/ijcard stress echocardiography has, to our knowledge, not yet been invariably associated with advanced coronary artery disease or an adverse outcome [10].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Significance of hypotensive response during dobutamine stress echocardiography

Dunkelgrün

Hoeks

Elhendy

et al. 2008

International Journal of Cardiology

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Section: Main Findingsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Significance of hypotensive response during dobutamine stress echocardiography

Dunkelgrün

Hoeks

Elhendy

et al. 2008

International Journal of Cardiology

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“…Ventricular fibrillation has also been reported rarely with dobutamine (30,36) and less frequently with exercise (1 3). Paradoxical hypotension has also been reported at a similar frequency with dobutamine, and is not associated with an adverse outcome (20,39). In general, the adverse events reported with arbutamine were well tolerated and resolved with termination of the arbutamine infusion.…”

Section: Clinical Experiencementioning

confidence: 82%

Arbutamine: A Novel Catecholamine for Pharmacologie Diagnosis of Coronary Disease

Young

Valcke

Mullane

et al. 1995

Cardiovascular Drug Reviews

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“…An inadequate increase in cardiac output may be due to inadequate contractile reserve, severe ischemic left ventricular dysfunction, or left-sided obstructive heart disease. Dynamic left ventricular cavity obliteration due to strong inotropic stimulation was proposed as an important cause for reduced cardiac output and hypotension, 22 especially in patients with dehydration, but later studies could not confirm this mechanism, 14 and the proposed bolus of saline before dobutamine 22,23 did not prevent cavity obliteration in a canine model. 24 The second mechanism, a disproportionate decrease in systemic vascular resistance may be due to excessive sensitivity of the peripheral circulation to b 2 -receptor stimulation, increased b 2 -receptor density (deconditioned patients), or to a neurally mediated mechanism in which vigorous myocardial contraction stimulates the intramyocardial mechanoreceptors, resulting in sympathetic withdrawal and enhanced parasympathetic activity (the Bezold-Jarisch reflex).…”

Section: Resultsmentioning

confidence: 98%

Prognostic Significance of Systolic Blood Pressure Changes During Dobutamine-Atropine Stress Technetium-99m Sestamibi Perfusion Scintigraphy in Patients With Chest Pain and Known or Suspected Coronary Artery Disease

Geleijnse

Elhendy

Domburg

et al. 1997

The American Journal of Cardiology

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To investigate the prognostic value of dobutamine stressinduced changes in systolic blood pressure (BP) 418 patients (mean age 60 years, 238 men) with chest pain and known or suspected coronary artery disease, who underwent a dobutamine-atropine stress technetium99m sestamibi myocardial perfusion scintigraphic study, were followed up for 25 { 15 months. Blood pressure was measured by automatic sphygmomanometry every 3 minutes. A marked decrease and increase in systolic BP from rest to peak were defined as changes of ¢20 mm Hg, and ¢30 mm Hg, respectively. Worst outcome events were cardiac death (n Å 30), nonfatal myocardial infarction (n Å 17), and hospitalization for congestive heart failure (n Å 8). A decrease in systolic BP (prevalence 16%) was associated with older age and higher baseline systolic BP. Fixed and reversible sestamibi perfusion defects and follow-up results were similar to patients without a systolic BP decrease. In contrast, an increase in systolic BP (prevalence 24%) was associated with younger age, lower baseline systolic BP, and with absence of a history of prior congestive heart failure or treatment with angiotensin-converting enzyme inhibitors. Furthermore, these patients had fewer fixed perfusion defects and tended to have fewer annual event rates (3.5% vs 7.5%, p õ0.10). In a multivariate model, an increase in systolic BP was not an independent predictor for subsequent events. In conclusion, a dobutamine-induced decrease in systolic BP is not associated with fixed or reversible sestamibi defects or adverse prognosis. An increase in systolic BP, however, is associated with less fixed sestamibi defects and a tendency toward less annual event rates. ᮊ1997 by Excerpta Medica, Inc.(Am J Cardiol 1997;79:1031-1035) D obutamine stress technetium-99m sestamibi myocardial perfusion scintigraphy is a pharmacologic stress modality with diagnostic 1-5 and prognostic 6 properties comparable to dobutamine stress echocardiography. Previous dobutamine stress echocardiographic studies have reported that dobutamine stress-induced hypotension is -unlike exercise -induced hypotension 7 -10 not related to new or worsening wall motion abnormalities 11 -14 and the presence or extent of coronary artery disease. 11,12Furthermore, a relatively small echocardiographic study 12 has supported these results with prognostic data that were similar for the hypotensive and the nonhypotensive group. To date, however, these findings were not confirmed by myocardial perfusion scintigraphic data. Also, it is not known whether a substantial increase in systolic blood pressure (BP)From the Thoraxcentre and the Department of Nuclear Medicine, University Hospital, Rotterdam-Dijkzigt and Erasmus University, Rotterdam, The Netherlands. This study was supported in part by funds from the Dutch Heart Foundation (Grant NHS 94.135), The Hague, The Netherlands, and Cairo University Hospital, Cairo, Egypt. Manuscript received July 16, 1996; revised manuscript received and accepted December 12, 1996.Address for reprints: Marcel L. Geleijn...

show abstract

Hypotension during dobutamine stress echocardiography: Initial description and clinical relevance

Cited by 61 publications

References 21 publications

Significance of hypotensive response during dobutamine stress echocardiography

Significance of hypotensive response during dobutamine stress echocardiography

Arbutamine: A Novel Catecholamine for Pharmacologie Diagnosis of Coronary Disease

Prognostic Significance of Systolic Blood Pressure Changes During Dobutamine-Atropine Stress Technetium-99m Sestamibi Perfusion Scintigraphy in Patients With Chest Pain and Known or Suspected Coronary Artery Disease

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