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Paolo G Camici - One of the best experts on this subject based on the ideXlab platform.
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Dobutamine induced hyperaemia inversely correlates with coronary artery stenosis severity and highlights dissociation between myocardial blood flow and oxygen consumption
Heart, 2006Co-Authors: Rohan Jagathesan, Edward Barnes, Stuart D Rosen, Rodney A Foale, Paolo G CamiciAbstract:Objectives: To compare the relationship between Dobutamine myocardial blood flow (MBF), rate–pressure product (RPP) and stenosis severity in patients with coronary artery disease (CAD). Methods: 27 patients with single-vessel CAD were allocated to three groups based on stenosis severity: group 1, 50–69% (n = 9); group 2, 70–89% (n = 9); and group 3, ⩾ 90% (n = 9). Nine normal volunteers served as controls. Resting and Dobutamine MBF were measured by positron emission tomography in the territory subtended by the stenosis (Isc) and remote myocardium (Rem). Mean left ventricular MBF was used for controls. Results: In group 1, mean Dobutamine MBF-Isc (2.48 (SD 0.48 ml/min/g)) and Dobutamine MBF-Rem (2.70 (0.50) ml/min/g, NS) were comparable. In groups 2 and 3, Dobutamine MBF-Isc (1.91 (0.44) and 1.22 (0.21) ml/min/g) was significantly lower than Dobutamine MBF-Rem (2.27 (0.28) and 1.98 (0.25) ml/min/g, p Conclusion: Dobutamine MBF inversely correlated with stenosis severity and achieved significant flow heterogeneity for coronary stenoses > 70%. Dobutamine MBF and RPP were dissociated in both Isc and Rem segments in patients compared with controls.
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comparison of myocardial blood flow and coronary flow reserve during Dobutamine and adenosine stress implications for pharmacologic stress testing in coronary artery disease
Journal of Nuclear Cardiology, 2006Co-Authors: Rohan Jagathesan, Edward Barnes, Stuart D Rosen, Rodney A Foale, Paolo G CamiciAbstract:Background Mechanistic differences between pharmacologic stressors may offer different clinical benefits. Therefore the effects of Dobutamine and adenosine on absolute myocardial blood flow (MBF) and coronary flow reserve (CFR) were compared. Methods and Results We divided 36 patients (mean age, 61 ± 8 years) with coronary artery disease into 2 groups based on stenosis severity as follows: greater than 50% but less than 75% (n = 16) and greater than 75% (n = 20). In addition, 18 normal volunteers (mean age, 46 ± 7 years) served as control subjects. Groups of equal sizes received either Dobutamine or adenosine. MBF at rest and peak MBF were measured by use of positron emission tomography in territories subtended by the stenosis (ischemic) and remote myocardium (remote), whereas left ventricular MBF was used in control subjects. CFR was calculated as peak MBF divided by MBF at rest. CFR was significantly greater with adenosine than with Dobutamine stress in control subjects and remote CFR. Ischemic CFR was blunted to a similar degree with each stressor. Therefore adenosine achieved flow heterogeneity across all coronary stenosis severities greater than 50%. However, Dobutamine achieved flow heterogeneity only in the presence of a severe coronary stenosis greater than 75% despite provoking a greater ischemic stimulus. Conclusion Adenosine stress demonstrated a higher sensitivity and Dobutamine demonstrated a higher specificity with quantitative perfusion imaging. Therefore adenosine is superior for diagnostic perfusion imaging, whereas Dobutamine is better suited in combination with visual imaging and in the functional assessment of a known coronary stenosis.
Paolo M Fioretti - One of the best experts on this subject based on the ideXlab platform.
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safety and prognostic value of early Dobutamine atropine stress echocardiography in patients with spontaneous chest pain and a non diagnostic electrocardiogram
European Heart Journal, 2000Co-Authors: M L Geleijnse, Abdou Elhendy, Paolo M Fioretti, Riccardo Rambaldi, J R T C Roelandt, Jaroslaw D Kasprzak, R T Van Domburg, Jan H Cornel, A P J Klootwijk, M L SimoonsAbstract:Aims To risk stratify and shorten hospital stay in patients with spontaneous (resting) chest pain and a non-diagnostic electrocardiogram (ECG). Methods and Results The study comprised 102 patients (mean age 58±12 years, 67 men) with spontaneous chest pain and a non-diagnostic ECG. Forty-three patients had suspected coronary artery disease and 59 had known (but of unknown actual significance) coronary artery disease. All patients underwent serial creatine kinase enzyme measurements, continuous ECG monitoring for at least 12h and early Dobutamine–atropine stress echocardiography in patients with negative creatine kinase enzymes and normal findings at ECG monitoring. Dobutamine–atropine stress echocardiography was considered positive in patients with new or worsening wall thickening abnormalities. Patients with negative Dobutamine–atropine stress echocardiography were discharged after the test. In-hospital and 6 month follow-up events noted were cardiac death, non-fatal myocardial infarction, unstable angina, and coronary artery bypass surgery or angioplasty. Thirteen patients had evidence of evolving myocardial infarction by elevated creatine kinase enzymes, or unstable angina by ECG monitoring. In the remaining 89 patients, Dobutamine–atropine stress echocardiography was performed after a median observation period of 31h (range 12–68h). During Dobutamine–atropine stress echocardiography no serious complications (death, non-fatal myocardial infarction, sustained ventricular tachycardia or ventricular fibrillation) occurred. Dobutamine–atropine stress echocardiography results were of poor quality in three, non-diagnostic in six, negative in 44 and positive in 36 patients. In the 80 patients with diagnostic Dobutamine–atropine stress echocardiography, variables associated with in-hospital events (n=7) were history of exertional angina ( P <0·005), chest pain score ( P <0·005), stress-induced angina ( P <0·001) and positive Dobutamine–atropine stress echocardiography ( P <0·005). Variables associated with follow-up events (n=11) were history of exertional angina ( P <0·05), chest pain score ( P <0·001), stress-induced angina ( P <0·01) and positive Dobutamine–atropine stress echocardiography ( P <0·01). At multivariate analysis the only significant predictor of events was positive Dobutamine–atropine stress echocardiography ( P <0·01). Conclusion Early Dobutamine–atropine stress echocardiography may safely distinguish between low- and high-risk subsets for subsequent cardiac events in patients with spontaneous chest pain and a non-diagnostic ECG.
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safety of Dobutamine atropine stress echocardiography in patients with suspected or proven coronary artery disease
American Journal of Cardiology, 1994Co-Authors: D Poldermans, Paolo M Fioretti, Jan H Cornel, Tamas Forster, Eric Boersma, Hero Van Urk, Mariarosaria Arnese, Jos R T CAbstract:Abstract The purpose of this study was to establish the safety of high-dose Dobutamine-atropine stress echocardlography in patients with suspected or proven coronary artery disease. Six hundred fifty consecutive examinations were completed. Mean age of patients was 61 years; 300 had a previous myocardial infarction. Heart rate increased from 73 to 129 beats/min during stress testing, blood pressure did not change significantly (from 140/81 to 150/80 mm Hg). Atropine was added to Dobutamine in 239 patients when no ischemia was induced with Dobutamine alone and the peak heart rate was
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enhanced sensitivity for detection of coronary artery disease by addition of atropine to Dobutamine stress echocardiography
American Journal of Cardiology, 1992Co-Authors: Albert J Mcneill, Alessandro Salustri, Paolo M Fioretti, El Said M Elsaid, Tamas Forster, Jos R T C RoelandtAbstract:Patients undergoing Dobutamine stress echocardiography often take beta antagonists which limit heart rate response and sensitivity in the test for detection of coronary artery disease. The aim of this study was to assess the effect of the addition of atropine to Dobutamine stress echocardiography on clinical, electrocardiographic and echocardiographic outcomes. Dobutamine stress echocardiography was performed starting at and increasing every 3 minutes with 10 micrograms/kg/min to a maximum of 40 micrograms/kg/min (stage 4), which was continued for 6 minutes. In patients not achieving 85% predicted maximal exercise heart rate and in whom the test was not judged positive on echocardiographic or electrocardiographic criteria, atropine (0.25 mg intravenously, repeated up to a maximum of 1 mg if necessary) was added and Dobutamine continued for up to a further 5 minutes, or until an adequate heart rate was achieved or the test was stopped because of chest pain or electrocardiographic changes. Of 80 consecutive patients undergoing Dobutamine stress echocardiography within 2 weeks of coronary angiography, 49 required atropine (group A) and 31 required only Dobutamine (group B). After Dobutamine alone, heart rate (mean +/- SD) was higher in group B than in group A: 129 +/- 20 vs 90 +/- 18 beats/min, p less than 0.0001; but after the addition of atropine, heart rate in group A increased to 120 +/- 20 beats/min. Overall sensitivity for the detection of coronary disease was 70%, 95% confidence interval (CI) 55 to 83%; after the addition of atropine, sensitivity for group A was 65%, 95% CI 45 to 81%; in group B, sensitivity was 81%, 95% CI 54 to 96%.(ABSTRACT TRUNCATED AT 250 WORDS)
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enhanced sensitivity for detection of coronary artery disease by addition of atropine to Dobutamine stress echocardiography
American Journal of Cardiology, 1992Co-Authors: Albert J Mcneill, Alessandro Salustri, Paolo M Fioretti, El Said M Elsaid, Tamas Forster, Jos R T C RoelandtAbstract:Patients undergoing Dobutamine stress echocardiography often take β antagonists which limit heart rate response and sensitivity in the test for detection of coronary artery disease. The aim of this study was to assess the effect of the addition of atropine to Dobutamine stress echocardiography on clinical, electrocardiographic and echocardiographic outcomes. Dobutamine stress echocardiography was performed starting at and increasing every 3 minutes with 10 μg/kg/min to a maximum of 40 μg/kg/min (stage 4), which was continued for 6 minutes. In patients not achieving 85% predicted maximal exercise heart rate and in whom the test was not judged positive on echocardiographic or electrocardiographic criteria, atropine (0.25 mg intravenously, repeated up to a maximum of 1 mg if necessary) was added and Dobutamine continued for up to a further 5 minutes, or until an adequate heart rate was achieved or the test was stopped because of chest pain or electrocardiographic changes. Of 80 consecutive patients undergoing Dobutamine stress echocardiography within 2 weeks of coronary angiography, 49 required atropine (group A) and 31 required only Dobutamine (group B). After Dobutamine alone, heart rate (mean ± SD) was higher in group B than in group A: 129 ± 20 vs 90 ± 18 beats/min, p < 0.0001; but after the addition of atropine, heart rate in group A increased to 120 ± 20 beats/min. Overall sensitivity for the detection of coronary disease was 70%, 95% confidence interval (CI) 55 to 83%; after the addition of atropine, sensitivity for group A was 65%, 95% CI 45 to 81%; in group B, sensitivity was 81%, 95% CI 54 to 96%. Overall specificity for the detection of coronary disease was 88%, 95% CI 72 to 97%; specificity was 89%, 95% CI 65 to 99% after atropine in group A and 87%, 95% CI 60 to 98% in group B. The addition of atropine did not reduce specificity of the test. There were no severe complications and no difference between groups in the frequency of complications or the need to administer β blockers for relief of symptoms. The addition of atropine to Dobutamine stress echocardiography in patients whose test results are negative and who do not achieve 85% predicted maximal heart rate during Dobutamine alone increases the sensitivity of the test for detection of coronary artery disease without loss of specificity and without severe adverse effects.
Adam P Bress - One of the best experts on this subject based on the ideXlab platform.
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effect of inpatient Dobutamine versus milrinone on out of hospital mortality in patients with acute decompensated heart failure
Pharmacotherapy, 2017Co-Authors: Jordan B King, Rashmee U Shah, Amy M Sainskinguyen, Joseph Biskupiak, Mark A Munger, Adam P BressAbstract:tudy Objective To determine the effect of Dobutamine versus milrinone on out-of-hospital mortality in treatment of patients with acute decompensated heart failure (ADHF). Design Propensity score weighted, retrospective cohort study with mortality as primary outcome. Setting An academic health-care system. Patients 500 adult patients with a prior history of heart failure, who survived a hospitalization for ADHF that included treatment with Dobutamine or milrinone between January 1, 2006 and April 30, 2014. Measurements and Main Results ADHF events were defined as a hospitalization with receipt of an intravenous loop diuretic or a Brain-type natriuretic peptide (BNP) value greater than 400 pg/mL during the hospitalization. Patients were followed until death or 180 days from hospital discharge. Risk ratios (RR) for mortality associated with Dobutamine compared to milrinone were calculated at 15, 30, and 180 days post-discharge using Poisson regression with robust error variance. Mean age was 62.7 years, 65.4% were male, and 48.2% had a mean left ventricular ejection fraction (LVEF) 40% or lower. Overall, 55 (18%) of Dobutamine-treated versus 23 (12%) of milrinone-treated patients died during follow-up (RR, 1.27; 95% CI, 0.76-2.13; p=0.360). For death from cardiovascular causes the RR for Dobutamine was 1.49 (95% CI, 0.79-2.82, p=0.214). For death from worsening heart failure the RR for Dobutamine was 2.55 (95% CI, 1.07-6.10, p=0.035). A trend towards significance was observed at 15-days post-discharge for all mortality analyses (all p-values <0.10). Conclusions Dobutamine was associated with higher short-term, out-of-hospital mortality compared with milrinone in patients with ADHF. These results replicate and extend prior associations with mortality and should be confirmed in a prospective study. This article is protected by copyright. All rights reserved.
Venu Menon - One of the best experts on this subject based on the ideXlab platform.
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contemporary outcomes in low gradient aortic stenosis patients who underwent Dobutamine stress echocardiography
Journal of the American Heart Association, 2019Co-Authors: Kimi Sato, Kesavan Sankaramangalam, Krishna Kandregula, Jennifer Bullen, Samir R Kapadia, Amar Krishnaswamy, Stephanie Mick, Leonardo L Rodriguez, Richard A Grimm, Venu MenonAbstract:Background Detection of flow reserve (FR) by Dobutamine stress echocardiography is used for risk stratification in low‐gradient aortic stenosis (AS). Prognostic significance of Dobutamine stress ec...
Abdou Elhendy - One of the best experts on this subject based on the ideXlab platform.
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long term prognostic value of Dobutamine stress echocardiography compared with myocardial perfusion scanning in patients unable to perform exercise tests
The American Journal of Medicine, 2004Co-Authors: Arend F L Schinkel, Abdou Elhendy, Roelf Valkema, R T Van Domburg, Jeroen J Bax, Eleni C Vourvouri, Manolis Bountioukos, Vittoria Rizzello, Elena Biagini, Eustachio AgricolaAbstract:Abstract Purpose To compare the long-term prognostic value of Dobutamine stress echocardiography and Dobutamine stress single photon emission computed tomography (SPECT) in patients unable to perform an exercise test. Methods We assessed the prognostic value of Dobutamine stress technetium 99m ( 99m Tc)-sestamibi SPECT and Dobutamine stress echocardiography in 301 patients who were unable to perform exercise tests. Outcomes during a mean (± SD) follow-up of 7.3 ± 2.8 years were overall death, cardiac death, nonfatal myocardial infarction, and late (>60 days) coronary revascularization. Results Abnormal myocardial perfusion was detected in 66% of patients (n = 198), while 60% (n = 182) had an abnormal stress echocardiogram; agreement was 82% (κ = 0.62). During the follow-up period, 100 deaths (33%) occurred, of which 43% were due to cardiac causes. Nonfatal myocardial infarction occurred in 23 patients (8%), and 29 (10%) underwent late revascularization. With stress SPECT, annual event rates were 0.7% for cardiac death and 3.6% for all cardiac events after a normal scan, and 2.6% for cardiac death and 6.5% for all cardiac events after an abnormal scan ( P P Conclusion Dobutamine stress 99m Tc-sestamibi SPECT and Dobutamine stress echocardiography provide comparable long-term prognostic information in addition to that afforded by clinical data.
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doppler tissue velocity sampling improves diagnostic accuracy during Dobutamine stress echocardiography for the assessment of viable myocardium in patients with severe left ventricular dysfunction
European Heart Journal, 2000Co-Authors: Riccardo Rambaldi, Abdou Elhendy, D Poldermans, J J Bax, E Boersma, Wim B Vletter, J R T C Roelandt, Roelf ValkemaAbstract:Background Both nuclear imaging with F18-fluorodeoxyglucose and Dobutamine stress echocardiography have been used to identify viable myocardium, although Dobutamine–stress echocardiography has been demonstrated to be the less sensitive of the two. Aim To compare the accuracy of pulsed-wave Doppler tissue sampling with Dobutamine–stress echocardiography for the detection of viable myocardium, using F18-fluorodeoxyglucose imaging as a reference. Methods Forty patients with chronic coronary artery disease and left ventricular dysfunction (mean ejection fraction 33±11%), underwent F18-fluorodeoxyglucose imaging, Dobutamine–stress echocardiography and pulsed-wave Doppler tissue sampling. Evaluation was performed using a six-segment model. Results Visual assessment by resting echo was feasible in 230 out of 240 segments (96%); 177 (77%) segments showed severe dyssynergy at rest. F18-fluorodeoxyglucose imaging showed viability in 95 (54%) segments while 82 (46%) were non-viable. Ejection phase velocity at rest was not significantly different; ejection velocities during low-dose and peak-dose Dobutamine, however, were significantly higher in viable myocardium (8·6±2·9 vs 6·0±1·8 and 9·3±31 vs 6·2±2·1cm.s−1). Using receiver operating characteristic curves the optimal cut-off value for viability assessment was an increase in the ejection phase velocity low-dose of 1±0·5cm.s−1, while 0±0·5cm.s−1predicted non-viability. The sensitivity and specificity (95%CI) of pulsed-wave Doppler tissue sampling and Dobutamine–stress echocardiography for the prediction of viability was respectively 87% (82–92) vs 75% (67–81) ( P <0·05) and 52% (44–59) vs 51% (45–59) ( P =ns). Conclusions The sensitivity of pulsed-wave Doppler tissue sampling is superior to Dobutamine–stress echocardiography for the assessment of myocardial viability.
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safety and prognostic value of early Dobutamine atropine stress echocardiography in patients with spontaneous chest pain and a non diagnostic electrocardiogram
European Heart Journal, 2000Co-Authors: M L Geleijnse, Abdou Elhendy, Paolo M Fioretti, Riccardo Rambaldi, J R T C Roelandt, Jaroslaw D Kasprzak, R T Van Domburg, Jan H Cornel, A P J Klootwijk, M L SimoonsAbstract:Aims To risk stratify and shorten hospital stay in patients with spontaneous (resting) chest pain and a non-diagnostic electrocardiogram (ECG). Methods and Results The study comprised 102 patients (mean age 58±12 years, 67 men) with spontaneous chest pain and a non-diagnostic ECG. Forty-three patients had suspected coronary artery disease and 59 had known (but of unknown actual significance) coronary artery disease. All patients underwent serial creatine kinase enzyme measurements, continuous ECG monitoring for at least 12h and early Dobutamine–atropine stress echocardiography in patients with negative creatine kinase enzymes and normal findings at ECG monitoring. Dobutamine–atropine stress echocardiography was considered positive in patients with new or worsening wall thickening abnormalities. Patients with negative Dobutamine–atropine stress echocardiography were discharged after the test. In-hospital and 6 month follow-up events noted were cardiac death, non-fatal myocardial infarction, unstable angina, and coronary artery bypass surgery or angioplasty. Thirteen patients had evidence of evolving myocardial infarction by elevated creatine kinase enzymes, or unstable angina by ECG monitoring. In the remaining 89 patients, Dobutamine–atropine stress echocardiography was performed after a median observation period of 31h (range 12–68h). During Dobutamine–atropine stress echocardiography no serious complications (death, non-fatal myocardial infarction, sustained ventricular tachycardia or ventricular fibrillation) occurred. Dobutamine–atropine stress echocardiography results were of poor quality in three, non-diagnostic in six, negative in 44 and positive in 36 patients. In the 80 patients with diagnostic Dobutamine–atropine stress echocardiography, variables associated with in-hospital events (n=7) were history of exertional angina ( P <0·005), chest pain score ( P <0·005), stress-induced angina ( P <0·001) and positive Dobutamine–atropine stress echocardiography ( P <0·005). Variables associated with follow-up events (n=11) were history of exertional angina ( P <0·05), chest pain score ( P <0·001), stress-induced angina ( P <0·01) and positive Dobutamine–atropine stress echocardiography ( P <0·01). At multivariate analysis the only significant predictor of events was positive Dobutamine–atropine stress echocardiography ( P <0·01). Conclusion Early Dobutamine–atropine stress echocardiography may safely distinguish between low- and high-risk subsets for subsequent cardiac events in patients with spontaneous chest pain and a non-diagnostic ECG.