Pathophysiologic mechanisms underlying dobutamine- and exercise-induced wall motion abnormalities.

Abstract:

BACKGROUND:Dobutamine and exercise echocardiography are accepted as tests of comparable efficacy for the diagnosis of coronary artery disease. Although dobutamine has been classified as "exercise simulating," the mechanisms of ischemia with dobutamine and exercise have not been well studied. This study sought to compare the determinants of myocardial oxygen consumption. METHODS AND RESULTS:We studied 54 patients with coronary artery disease undergoing dobutamine and exercise stress. A subgroup of 13 patients with comparable degrees of wall motion abnormalities and ST-segment changes during both stresses were selected to compare the determinants of ischemia in comparable circumstances. Dobutamine was infused to a mean maximal dose of 32+/-8 microg/kg/min, and exercise was stopped at an average of 135+/-25 W. The mean regional wall motion score was not statistically different between the two protocols (p = 0.27). At the onset of wall motion abnormalities and peak stress, the heart rate increased significantly less during dobutamine than during exercise (106+/-23 vs 126+/-19 beats/min, p < 0.001). The same was true of systolic blood pressure (155+/-21 vs 205+/-24 mm Hg, p < 0.001) and the rate-pressure product (16.5+/-4.6 vs 25.9+/-5, p < 0.001). Cardiac volumes were similar during both tests. CONCLUSIONS:Ischemia occurs at a lower level of external cardiac work during dobutamine than during exercise stress. We suspect that additional mechanisms, such as the oxygen wasting effect of dobutamine, may be responsible for this observation.

journal_name

Am Heart J

journal_title

American heart journal

authors

Mairesse GH,Vanoverschelde JL,Robert A,Climov D,Detry JM,Marwick TH

doi

10.1016/s0002-8703(98)70183-8

subject

Has Abstract

pub_date

1998-07-01 00:00:00

pages

63-70

issue

1

eissn

0002-8703

issn

1097-6744

pii

S0002870398001847

journal_volume

136

pub_type

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