Significance of hypotension and vasovagal reflex during echo-stress using high doses of dobutamine

• Published in: Cardiologia (Rome, Italy) Vol. 42; no. 3; p. 287
• Main Authors: Scandura, S, Felis, S, Barbagallo, G, Deste, W, Drago, A, D'Aleo, P, Calvi, V, Giuffrida, G
• Format: Journal Article
• Language: Italian
• Published: Italy 01.03.1997
• Subjects: Aged; Bradycardia - etiology; Coronary Angiography; Coronary Disease - diagnosis; Coronary Disease - diagnostic imaging; Data Interpretation, Statistical; Dobutamine - administration & dosage; Echocardiography; Electrocardiography; Female; Humans; Hypotension - etiology; Male; Middle Aged; Reflex - physiology; Vagus Nerve - physiology
• ISSN: 0393-1978

Coronary artery disease (CAD) is one of the main causes of cardiovascular morbility and mortality. Actual research lines are directed towards the discovery of silent CAD before hard events as myocardial infarction and sudden death. Dobutamine stress echocardiography is an useful method to assess patients with suspected CAD who, are not able to stand an effort because of physical reasons. During the test, hypotension and/or bradycardia may occur and may cause interruption of the test. The aim of our study was to consider prevalence, meaning and clinical implications of hypotensive, sometimes associated to bradycardia, during dobutamine stress echocardiography. From April 1994 to June 1996, 363 consecutive patients (267 men and 96 women with an average age of 59.3 +/- 10 year) were examined because of suspected or known ischemic cardiopathy. All patients underwent dobutamine stress echocardiography and coronary arteriography. Neither hypotension nor bradycardia was noted in 285 of our patients (78.51%), while in the remaining 78 patients (21.48%) there was a pressure drop > or = 20 mmHg; bradycardia appeared in 6 patients. The study shows that it does not exist a statistically significant difference between the percentage of the patients with CAD of the control group and those of the hypotensive group (91.9 vs 83.3%, NS). As for the changes in well motion score index, there was not a statistically significant difference between patients improved score index in the control group and in the hypotensive group (80 vs 74.3%, NS). The 6 patients with hypotension and bradycardia had normal coronary arteries. In the light of these results hypotension, alone or associated with bradycardia, should not be considered as a negative prognostic factor and should not induce to the interruption of the dobutamine stress echocardiography.