Document Detail


Side effects of high-dose dobutamine are not prevented by normal saline infusion in dobutamine stress echocardiography.
MedLine Citation:
PMID:  18445058     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
High-dose dobutamine used in dobutamine stress echocardiography (DSE) has hemodynamically based side effects due to a variable combination of beta1 (inotropic) and beta2 (vasodilator) effects. Of concern is the development of an "empty ventricle syndrome" associated with intracavitary or outflow tract obstruction and resultant symptomatic hypotension. This study was undertaken to determine whether the concurrent administration of normal saline (N/S) would decrease symptoms, limit the development of left ventricular outflow tract (LVOT) obstruction and hypotension by maintaining left ventricular volume. One hundred patients, mean age 66 years +/- 12, presenting for a DSE were randomized into two groups. One group (n = 50) received N/S at a rate of 800 ml/hour during the test, the second group received dobutamine alone. Patients were instructed to report and quantify symptoms on a scale of 1 to 10. Echocardiographic measurements of end systolic volume (ESV) and LVOT gradients were taken prior to dobutamine and at peak dose. There was no difference in symptom scores (3.5 +/- 5.1(N/S) vs. 3.0 +/- 4.7, P = 0.6), change in systolic blood pressure (BP) (-0.74 mmHg +/- 33 (N/S) vs. -0.89 +/- 35, P = 0.9) maximum LVOT gradient at peak (16.4 mmHg +/- 16.1 (N/S) vs. 13.9 mmHg +/- 9, P = 0.4), or ESV at peak (17.9 mL +/- 13.4 (N/S) vs. 15.5 ml +/- 10.6, P = 0.37). Furthermore, there was no difference in the number of patients (10/50 (20%) in both groups) who developed a significant LVOT gradient, defined as greater than 20 mmHg at peak dose. Despite the sound theoretical basis of N/S infusion to protect against "empty ventricle syndrome" during DSE this randomized trial does not demonstrate any symptomatic or hemodynamic benefit.
Authors:
Tracy Hecker; Carmine G De Pasquale; Rebecca Perry; Lynn Brown; Hari Koutsounis; Majo X Joseph
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial     Date:  2008-04-27
Journal Detail:
Title:  Echocardiography (Mount Kisco, N.Y.)     Volume:  25     ISSN:  1540-8175     ISO Abbreviation:  Echocardiography     Publication Date:  2008 Aug 
Date Detail:
Created Date:  2008-08-29     Completed Date:  2009-01-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8511187     Medline TA:  Echocardiography     Country:  United States    
Other Details:
Languages:  eng     Pagination:  712-6     Citation Subset:  IM    
Affiliation:
Cardiac Services, Flinders Medical Centre, Bedford Park, South Australia, Australia. tracyhecker@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Aged
Blood Pressure Determination
Cardiac Output / drug effects
Dobutamine / adverse effects,  diagnostic use,  pharmacology*
Dose-Response Relationship, Drug
Echocardiography, Stress / adverse effects*,  methods
Female
Follow-Up Studies
Hemodynamics / drug effects
Humans
Hypotension / diagnosis,  etiology,  prevention & control*
Infusions, Intravenous
Male
Middle Aged
Probability
Reference Values
Risk Assessment
Sodium Chloride / therapeutic use*
Ventricular Outflow Obstruction / etiology,  prevention & control*
Chemical
Reg. No./Substance:
34368-04-2/Dobutamine; 7647-14-5/Sodium Chloride

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


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