Accelerated dobutamine stress testing: Feasibility and safety in patients with moderate aortic stenosis

Abstract

Objective: A continuous infusion of a single high dose of dobutamine was suggested as a simple protocol of dobutamine stress echocardiography (DSE). The present study explores the feasibility and safety of an accelerated DSE protocol in patients with calcific moderate valvular aortic stenosis undergoing DSE for evaluation of suspected coronary artery disease. Methods: Eligible patients (n = 100) were prospectively enrolled. They were randomly assigned to undergo either the accelerated (group A, 50 patients) or the conventional protocol (group B, 50 patients). Group A received a continuous infusion of 40 μg/kg/min ± 1–2 mg atropine. Patients were monitored for adverse drug effects. Test duration was recorded. Patients with positive stress results underwent coronary angiography (CA). Results: Mean age of the study cohort was 62.29 ± 9.8 years, 62 (62%) being males. Mean pressure gradient across the aortic valve was recorded (group A: 32.2 mmHg and group B: 31.16 mmHg, P < 0.05). Group B showed a longer mean test duration (17.9 ± 2.3 vs. 8.9 ± 1.9 min, P < 0.001) and higher mean weight-adjusted cumulative dobutamine dose (385 ± 115 vs. 350 ± 110.24 μg/kg, P < 0.05). The two groups received a similar total dose of atropine. Group A patients showed significantly lower incidence of extra-systoles, non-sustained ventricular tachycardia and severe hypotension (P < 0.05). CA results yielded almost similar diagnostic outcomes in both groups. Conclusion: In patients with calcific moderate aortic stenosis undergoing DSE; adopting the described accelerated protocol is associated with shorter test duration, lower weight-adjusted cumulative dobutamine dose for target heart rate achievement and fewer adverse effects, while maintaining a comparable diagnostic value.

Keywords

• Dobutamine stress echocardiography
• Moderate aortic stenosis
• Accelerated protocol
• Safety