Skip to main content
The Texas Heart Institute Journal logoLink to The Texas Heart Institute Journal
. 1994;21(3):202–210.

Dobutamine stress echocardiography in clinical practice with a review of the recent literature.

E Barasch 1, S Wilansky 1
PMCID: PMC325166  PMID: 8000267

Abstract

Stress echocardiography has been developed in recent years as an effective noninvasive test for the detection and assessment of coronary artery disease. This method combines exercise with 2-dimensional echocardiography, which can assess regional and global left ventricular function during stress. Dobutamine infusion, a pharmacologic means of producing cardiovascular stress, appears to be an excellent alternative to exercise in echocardiographic studies. Currently, it is reserved for patients who cannot exercise at a meaningful level because of advanced age, physical deconditioning, or other factors. This review evaluates the current clinical application of dobutamine stress echocardiography and compares its efficacy with that of exercise echocardiography and nuclear perfusion imaging.

Full text

PDF
206

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bach D. S., Hepner A., Marcovitz P. A., Armstrong W. F. Dobutamine stress echocardiography: prevalence of a nonischemic response in a low-risk population. Am Heart J. 1993 May;125(5 Pt 1):1257–1261. doi: 10.1016/0002-8703(93)90992-i. [DOI] [PubMed] [Google Scholar]
  2. Baudhuin T., Marwick T., Melin J., Wijns W., D'Hondt A. M., Detry J. M. Diagnosis of coronary artery disease in elderly patients: safety and efficacy of dobutamine echocardiography. Eur Heart J. 1993 Jun;14(6):799–803. doi: 10.1093/eurheartj/14.6.799. [DOI] [PubMed] [Google Scholar]
  3. Buda A. J., Zotz R. J., Gallagher K. P. Characterization of the functional border zone around regionally ischemic myocardium using circumferential flow-function maps. J Am Coll Cardiol. 1986 Jul;8(1):150–158. doi: 10.1016/s0735-1097(86)80106-1. [DOI] [PubMed] [Google Scholar]
  4. Cigarroa C. G., deFilippi C. R., Brickner M. E., Alvarez L. G., Wait M. A., Grayburn P. A. Dobutamine stress echocardiography identifies hibernating myocardium and predicts recovery of left ventricular function after coronary revascularization. Circulation. 1993 Aug;88(2):430–436. doi: 10.1161/01.cir.88.2.430. [DOI] [PubMed] [Google Scholar]
  5. Cohen J. L., Ottenweller J. E., George A. K., Duvvuri S. Comparison of dobutamine and exercise echocardiography for detecting coronary artery disease. Am J Cardiol. 1993 Dec 1;72(17):1226–1231. doi: 10.1016/0002-9149(93)90288-n. [DOI] [PubMed] [Google Scholar]
  6. Gallagher K. P., Matsuzaki M., Osakada G., Kemper W. S., Ross J., Jr Effect of exercise on the relationship between myocardial blood flow and systolic wall thickening in dogs with acute coronary stenosis. Circ Res. 1983 Jun;52(6):716–729. doi: 10.1161/01.res.52.6.716. [DOI] [PubMed] [Google Scholar]
  7. Hertzer N. R., Beven E. G., Young J. R., O'Hara P. J., Ruschhaupt W. F., 3rd, Graor R. A., Dewolfe V. G., Maljovec L. C. Coronary artery disease in peripheral vascular patients. A classification of 1000 coronary angiograms and results of surgical management. Ann Surg. 1984 Feb;199(2):223–233. doi: 10.1097/00000658-198402000-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Hirzel H. O., Nuesch K., Gruentzig A. R., Luetolf U. M. Short- and long-term changes in myocardial perfusion after percutaneous transluminal coronary angioplasty assessed by thallium-201 exercise scintigraphy. Circulation. 1981 May;63(5):1001–1007. doi: 10.1161/01.cir.63.5.1001. [DOI] [PubMed] [Google Scholar]
  9. Jaarsma W., Visser C. A., Kupper A. J., Res J. C., van Eenige M. J., Roos J. P. Usefulness of two-dimensional exercise echocardiography shortly after myocardial infarction. Am J Cardiol. 1986 Jan 1;57(1):86–90. doi: 10.1016/0002-9149(86)90957-4. [DOI] [PubMed] [Google Scholar]
  10. Lunkenheimer P. P., Redmann K., Isringhaus H., Flameng W., Rettig G., Whimster W. F. Cardiodynamic effects of dopamine and dobutamine. Thorac Cardiovasc Surg. 1992 Jun;40(3):135–139. doi: 10.1055/s-2007-1020131. [DOI] [PubMed] [Google Scholar]
  11. Marcovitz P. A., Armstrong W. F. Accuracy of dobutamine stress echocardiography in detecting coronary artery disease. Am J Cardiol. 1992 May 15;69(16):1269–1273. doi: 10.1016/0002-9149(92)91219-t. [DOI] [PubMed] [Google Scholar]
  12. Martin T. W., Seaworth J. F., Johns J. P., Pupa L. E., Condos W. R. Comparison of adenosine, dipyridamole, and dobutamine in stress echocardiography. Ann Intern Med. 1992 Feb 1;116(3):190–196. doi: 10.7326/0003-4819-116-3-190. [DOI] [PubMed] [Google Scholar]
  13. Marwick T., Willemart B., D'Hondt A. M., Baudhuin T., Wijns W., Detry J. M., Melin J. Selection of the optimal nonexercise stress for the evaluation of ischemic regional myocardial dysfunction and malperfusion. Comparison of dobutamine and adenosine using echocardiography and 99mTc-MIBI single photon emission computed tomography. Circulation. 1993 Feb;87(2):345–354. doi: 10.1161/01.cir.87.2.345. [DOI] [PubMed] [Google Scholar]
  14. Marzullo P., Parodi O., Reisenhofer B., Sambuceti G., Picano E., Distante A., Gimelli A., L'Abbate A. Value of rest thallium-201/technetium-99m sestamibi scans and dobutamine echocardiography for detecting myocardial viability. Am J Cardiol. 1993 Jan 15;71(2):166–172. doi: 10.1016/0002-9149(93)90733-s. [DOI] [PubMed] [Google Scholar]
  15. Mazeika P. K., Nadazdin A., Oakley C. M. Clinical significance of abrupt vasodepression during dobutamine stress echocardiography. Am J Cardiol. 1992 Jun 1;69(17):1484–1486. doi: 10.1016/0002-9149(92)90907-g. [DOI] [PubMed] [Google Scholar]
  16. Mazeika P. K., Nadazdin A., Oakley C. M. Dobutamine stress echocardiography for detection and assessment of coronary artery disease. J Am Coll Cardiol. 1992 May;19(6):1203–1211. doi: 10.1016/0735-1097(92)90325-h. [DOI] [PubMed] [Google Scholar]
  17. Mazeika P. K., Nadazdin A., Oakley C. M. Stress Doppler echocardiography using dobutamine in coronary patients with and without ischaemia induction. Eur Heart J. 1992 Aug;13(8):1020–1027. doi: 10.1093/oxfordjournals.eurheartj.a060308. [DOI] [PubMed] [Google Scholar]
  18. McGillem M. J., DeBoe S. F., Friedman H. Z., Mancini G. B. The effects of dopamine and dobutamine on regional function in the presence of rigid coronary stenoses and subcritical impairments of reactive hyperemia. Am Heart J. 1988 May;115(5):970–977. doi: 10.1016/0002-8703(88)90065-8. [DOI] [PubMed] [Google Scholar]
  19. Meyer S. L., Curry G. C., Donsky M. S., Twieg D. B., Parkey R. W., Willerson J. T. Influence of dobutamine on hemodynamics and coronary blood flow in patients with and without coronary artery disease. Am J Cardiol. 1976 Jul;38(1):103–108. doi: 10.1016/0002-9149(76)90070-9. [DOI] [PubMed] [Google Scholar]
  20. Nanto S., Masuyama T., Lim Y. J., Hori M., Kodama K., Kamada T. Demonstration of functional border zone with myocardial contrast echocardiography in human hearts. Simultaneous analysis of myocardial perfusion and wall motion abnormalities. Circulation. 1993 Aug;88(2):447–453. doi: 10.1161/01.cir.88.2.447. [DOI] [PubMed] [Google Scholar]
  21. Pellikka P. A., Oh J. K., Bailey K. R., Nichols B. A., Monahan K. H., Tajik A. J. Dynamic intraventricular obstruction during dobutamine stress echocardiography. A new observation. Circulation. 1992 Nov;86(5):1429–1432. doi: 10.1161/01.cir.86.5.1429. [DOI] [PubMed] [Google Scholar]
  22. Picano E. Stress echocardiography. From pathophysiological toy to diagnostic tool. Circulation. 1992 Apr;85(4):1604–1612. doi: 10.1161/01.cir.85.4.1604. [DOI] [PubMed] [Google Scholar]
  23. Piérard L. A., Berthe C., Albert A., Carlier J., Kulbertus H. E. Haemodynamic alterations during ischaemia induced by dobutamine stress testing. Eur Heart J. 1989 Sep;10(9):783–790. doi: 10.1093/oxfordjournals.eurheartj.a059571. [DOI] [PubMed] [Google Scholar]
  24. Poldermans D., Fioretti P. M., Forster T., Thomson I. R., Boersma E., el-Said E. M., du Bois N. A., Roelandt J. R., van Urk H. Dobutamine stress echocardiography for assessment of perioperative cardiac risk in patients undergoing major vascular surgery. Circulation. 1993 May;87(5):1506–1512. doi: 10.1161/01.cir.87.5.1506. [DOI] [PubMed] [Google Scholar]
  25. Pozzoli M. M., Fioretti P. M., Salustri A., Reijs A. E., Roelandt J. R. Exercise echocardiography and technetium-99m MIBI single-photon emission computed tomography in the detection of coronary artery disease. Am J Cardiol. 1991 Feb 15;67(5):350–355. doi: 10.1016/0002-9149(91)90040-r. [DOI] [PubMed] [Google Scholar]
  26. Previtali M., Lanzarini L., Fetiveau R., Poli A., Ferrario M., Falcone C., Mussini A. Comparison of dobutamine stress echocardiography, dipyridamole stress echocardiography and exercise stress testing for diagnosis of coronary artery disease. Am J Cardiol. 1993 Oct 15;72(12):865–870. doi: 10.1016/0002-9149(93)91097-2. [DOI] [PubMed] [Google Scholar]
  27. Rosamond T. L., Vacek J. L., Hurwitz A., Rowland A. J., Beauchamp G. D., Crouse L. J. Hypotension during dobutamine stress echocardiography: initial description and clinical relevance. Am Heart J. 1992 Feb;123(2):403–407. doi: 10.1016/0002-8703(92)90652-c. [DOI] [PubMed] [Google Scholar]
  28. Ross J., Jr Mechanisms of regional ischemia and antianginal drug action during exercise. Prog Cardiovasc Dis. 1989 May-Jun;31(6):455–466. doi: 10.1016/0033-0620(89)90020-0. [DOI] [PubMed] [Google Scholar]
  29. Rude R. E., Izquierdo C., Buja L. M., Willerson J. T. Effects of inotropic and chronotropic stimuli on acute myocardial ischemic injury. I. Studies with dobutamine in the anesthetized dog. Circulation. 1982 Jun;65(7):1321–1328. doi: 10.1161/01.cir.65.7.1321. [DOI] [PubMed] [Google Scholar]
  30. Ruffolo R. R., Jr, Spradlin T. A., Pollock G. D., Waddell J. E., Murphy P. J. Alpha and beta adrenergic effects of the stereoisomers of dobutamine. J Pharmacol Exp Ther. 1981 Nov;219(2):447–452. [PubMed] [Google Scholar]
  31. Ruffolo R. R., Jr The pharmacology of dobutamine. Am J Med Sci. 1987 Oct;294(4):244–248. doi: 10.1097/00000441-198710000-00005. [DOI] [PubMed] [Google Scholar]
  32. Ryan T., Armstrong W. F., O'Donnell J. A., Feigenbaum H. Risk stratification after acute myocardial infarction by means of exercise two-dimensional echocardiography. Am Heart J. 1987 Dec;114(6):1305–1316. doi: 10.1016/0002-8703(87)90530-8. [DOI] [PubMed] [Google Scholar]
  33. Ryan T., Vasey C. G., Presti C. F., O'Donnell J. A., Feigenbaum H., Armstrong W. F. Exercise echocardiography: detection of coronary artery disease in patients with normal left ventricular wall motion at rest. J Am Coll Cardiol. 1988 May;11(5):993–999. doi: 10.1016/s0735-1097(98)90056-0. [DOI] [PubMed] [Google Scholar]
  34. Salustri A., Fioretti P. M., McNeill A. J., Pozzoli M. M., Roelandt J. R. Pharmacological stress echocardiography in the diagnosis of coronary artery disease and myocardial ischaemia: a comparison between dobutamine and dipyridamole. Eur Heart J. 1992 Oct;13(10):1356–1362. doi: 10.1093/oxfordjournals.eurheartj.a060066. [DOI] [PubMed] [Google Scholar]
  35. Sawada S. G., Segar D. S., Ryan T., Brown S. E., Dohan A. M., Williams R., Fineberg N. S., Armstrong W. F., Feigenbaum H. Echocardiographic detection of coronary artery disease during dobutamine infusion. Circulation. 1991 May;83(5):1605–1614. doi: 10.1161/01.cir.83.5.1605. [DOI] [PubMed] [Google Scholar]
  36. Schiller N. B., Shah P. M., Crawford M., DeMaria A., Devereux R., Feigenbaum H., Gutgesell H., Reichek N., Sahn D., Schnittger I. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr. 1989 Sep-Oct;2(5):358–367. doi: 10.1016/s0894-7317(89)80014-8. [DOI] [PubMed] [Google Scholar]
  37. Segar D. S., Brown S. E., Sawada S. G., Ryan T., Feigenbaum H. Dobutamine stress echocardiography: correlation with coronary lesion severity as determined by quantitative angiography. J Am Coll Cardiol. 1992 May;19(6):1197–1202. doi: 10.1016/0735-1097(92)90324-g. [DOI] [PubMed] [Google Scholar]
  38. Simek C. L., Watson D. D., Smith W. H., Vinson E., Kaul S. Dipyridamole thallium-201 imaging versus dobutamine echocardiography for the evaluation of coronary artery disease in patients unable to exercise. Am J Cardiol. 1993 Dec 1;72(17):1257–1262. doi: 10.1016/0002-9149(93)90293-l. [DOI] [PubMed] [Google Scholar]
  39. Wann L. S., Faris J. V., Childress R. H., Dillon J. C., Weyman A. E., Feigenbaum H. Exercise cross-sectional echocardiography in ischemic heart disease. Circulation. 1979 Dec;60(6):1300–1308. doi: 10.1161/01.cir.60.6.1300. [DOI] [PubMed] [Google Scholar]
  40. Warner M. F., Pippin J. J., DiSciascio G., Paulsen W. H., Arrowood J. A., Tatum J. L., Goudreau E., Vetrovec G. W. Assessment of thallium scintigraphy and echocardiography during dobutamine infusion for the detection of coronary artery disease. Cathet Cardiovasc Diagn. 1993 Jun;29(2):122–127. doi: 10.1002/ccd.1810290207. [DOI] [PubMed] [Google Scholar]
  41. Williams M. E., Gervino E. V., Rosa R. M., Landsberg L., Young J. B., Silva P., Epstein F. H. Catecholamine modulation of rapid potassium shifts during exercise. N Engl J Med. 1985 Mar 28;312(13):823–827. doi: 10.1056/NEJM198503283121304. [DOI] [PubMed] [Google Scholar]

Articles from Texas Heart Institute Journal are provided here courtesy of Texas Heart Institute

RESOURCES