Accelerated dobutamine stress echocardiography protocol versus the standard one in the assessment of coronary artery disease

Abstract

Objectives: The steady-state concentration of dobutamine at any infusion rate is not reached except after 10 min. Nevertheless, dobutamine stress echocardiography (DSE) still employs an incremental 3-min interval infusion protocol. Constant infusion of a higher dobutamine dose appears to overcome this pitfall. We aimed to evaluate the safety and efficacy of an accelerated DSE protocol for the assessment of coronary artery disease. Methods: From June 2018 to January 2019, forty consecutive patients underwent accelerated protocol for DSE (constant infusion of 50 μg/kg/min, with discontinuation of infusion at 10 min if no stress endpoint appears). Their hemodynamic responses and adverse effects' profile were compared to a control group (40 patients who underwent the standard protocol within the preceding 6 months). Results: Both groups were matched in all baseline characteristics. Peak heart rate (HR) (143 ± 13 vs. 145 ± 13 bpm, P = 0.54) and peak systolic blood pressure (160 ± 29 vs. 155 ± 42 mmHg, P = 0.53) were similar in both protocols. The accelerated protocol produced a significantly more rapid increase in HR (11.5 ± 2.3 vs. 5.3 ± 1.3 bpm, P< 0.001) and resulted in marked reduction in test duration (6 ± 2 vs. 14 ± 3 min, P < 0.001). The mean total cumulative dobutamine dose was lower in the accelerated group (275 ± 63 vs. 355 ± 144 μg/kg, P = 0.029). Both groups experienced similar rates of both arrhythmic and nonarrhythmic adverse effects. Conclusion: Accelerated DSE protocol seems as feasible, safe, effective, and more time-saving compared to the standard one. This might be of value to busy echocardiographic laboratories.

Keywords

• coronary artery disease
• dobutamine
• stress echocardiography