| Dobutamine pharmacodynamics during dobutamine stress echocardiography and the impact of beta-blocker withdrawal: a report from the Women's Ischemic Syndrome Evaluation Study. | |
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MedLine Citation:
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PMID: 12173796 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Larisa M Humma; Heather E Richardson; Jannet F Lewis; Susan P McGorray; Carl J Pepine; Julie A Johnson |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: Pharmacotherapy Volume: 22 ISSN: 0277-0008 ISO Abbreviation: Pharmacotherapy Publication Date: 2002 Aug |
Date Detail:
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Created Date: 2002-08-13 Completed Date: 2003-02-26 Revised Date: 2007-11-14 |
Medline Journal Info:
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Nlm Unique ID: 8111305 Medline TA: Pharmacotherapy Country: United States |
Other Details:
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Languages: eng Pagination: 939-46 Citation Subset: IM |
Affiliation:
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Department of Pharmacy Practice, University of Florida, Gainesville 32610-0486, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adrenergic beta-Antagonists
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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:
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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:
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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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