Document Detail


Dobutamine pharmacodynamics during dobutamine stress echocardiography and the impact of beta-blocker withdrawal: a report from the Women's Ischemic Syndrome Evaluation Study.
MedLine Citation:
PMID:  12173796     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY OBJECTIVES: To determine the pharmacodynamic parameters of dobutamine during dobutamine stress echocardiography (DSE) and to determine how beta-blocker withdrawal the evening before DSE affects responses to dobutamine during DSE. DESIGN: Retrospective analysis. SETTING: University medical center. PATIENTS: One hundred thirty-six women who had chest pain or other symptoms suggestive of myocardial ischemia and were considered to have a clinical indication for coronary angiography MEASUREMENTS AND MAIN RESULTS: Patients underwent DSE with dobutamine dosages titrated from 5 to 40 microg/kg/minute. The infusion was terminated if the patient reached target heart rate or symptoms developed. Those taking beta-blockers withheld their doses the evening before DSE. Traditional pharmacodynamic modeling revealed a wide range in responses to dobutamine. Data for 62% of patients not taking beta-blockers were described by the Emax (maximum heart rate response to dobutamine) model, whereas data for only 39% of patients taking beta-blockers were best described by this model (p = 0.01). Patients taking beta-blockers also had a smaller mean increment in left ventricular ejection fraction (10.8% +/- 4.2% vs 14.1% +/- 9.3%, p < 0.01), a trend toward a higher ED50 (dobutamine dosage rate causing half the maximum heart-rate response; median 16.8 microg/kg/min, p = 0.12) and a lower sigmoidicity factor determining the shape of the curve (median 2.1, p = 0.03). CONCLUSION: The response to dobutamine exhibits wide interpatient variability, even in the absence of beta-blockade. Nonetheless, in the absence of beta-blockers, in most patients the dobutamine response reaches a plateau by the time the maximum infusion rate (40 microg/kg/min) is reached. Withdrawal of beta-blockers the evening before DSE may be inadequate time for elimination of beta-blocker effect, requiring the addition of atropine to achieve the desired response during DSE.
Authors:
Larisa M Humma; Heather E Richardson; Jannet F Lewis; Susan P McGorray; Carl J Pepine; Julie A Johnson
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Pharmacotherapy     Volume:  22     ISSN:  0277-0008     ISO Abbreviation:  Pharmacotherapy     Publication Date:  2002 Aug 
Date Detail:
Created Date:  2002-08-13     Completed Date:  2003-02-26     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  8111305     Medline TA:  Pharmacotherapy     Country:  United States    
Other Details:
Languages:  eng     Pagination:  939-46     Citation Subset:  IM    
Affiliation:
Department of Pharmacy Practice, University of Florida, Gainesville 32610-0486, USA.
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / pharmacology*,  therapeutic use
Dobutamine / diagnostic use,  pharmacology*
Echocardiography, Stress / drug effects*
Female
Heart Rate / drug effects
Hospitals, University
Humans
Myocardial Ischemia / drug therapy,  physiopathology,  ultrasonography*
Retrospective Studies
Substance Withdrawal Syndrome
Grant Support
ID/Acronym/Agency:
M01-RR00425/RR/NCRR NIH HHS; N01-HV68161/HV/NHLBI NIH HHS; N01-HV68162/HV/NHLBI NIH HHS; N01-HV68163/HV/NHLBI NIH HHS; N01-HV68164/HV/NHLBI NIH HHS; R01-HL64691/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 34368-04-2/Dobutamine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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