Effects of Isoproterenol Administration in Dobutamine Stress Echocardiography

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques Pub Date : 2025-01-28 DOI:10.1111/echo.70081

Puja A. Patel, Zachary N. Parsia, Tsion Aberra, Nayrana Tillman, Martin Mathias, Adam Newell Bohn Johnson, Akanksha Girish, Brototo Deb, Carolina Valdiviezo, Christy Kaiser, Monvadi B. Srichai

{"title":"Effects of Isoproterenol Administration in Dobutamine Stress Echocardiography","authors":"Puja A. Patel, Zachary N. Parsia, Tsion Aberra, Nayrana Tillman, Martin Mathias, Adam Newell Bohn Johnson, Akanksha Girish, Brototo Deb, Carolina Valdiviezo, Christy Kaiser, Monvadi B. Srichai","doi":"10.1111/echo.70081","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objective</h3>\n \n <p>This study evaluated the safety and efficacy of isoproterenol administration as an adjunct for achievement of target heart rate (HR) during dobutamine stress echocardiography (DSE).</p>\n </section>\n \n <section>\n \n <h3> Background</h3>\n \n <p>In DSE, optimal accuracy is achieved when a target HR of 85% of maximal predicted heart rate (MPHR) is attained. Although rarely studied, intravenous isoproterenol has been used as an adjunct therapy to dobutamine and atropine to increase chronotropic response during pharmacologic stress testing.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We identified 5569 DSE studies during which 264 received isoproterenol at MedStar Georgetown University Hospital from August 2011 to March 2023. Of the studies receiving isoproterenol, we collected clinical and echocardiographic parameters from each study to assess the effects of isoproterenol administration, including downstream events.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>In 264 examinations with isoproterenol, 169 (64%) achieved 85% MPHR. Among these, 103 (39%) developed premature ventricular contractions, 79 (30%) developed symptoms including nausea/vomiting in 44 (17%), and chest pain in 15 (6%). There was a hypertensive response to stress in 53 studies (20%) and a hypotensive response in 37 studies (14%). There was no significant increase in 30-day and 1-year death when compared to studies that did not receive isoproterenol.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Isoproterenol can effectively be used as an adjunctive agent in DSE to achieve the requisite hemodynamic stress for evaluation of ischemia, with a similar rate of side effects and complications compared to dobutamine and atropine stress testing.</p>\n </section>\n </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"42 2","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/echo.70081","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

This study evaluated the safety and efficacy of isoproterenol administration as an adjunct for achievement of target heart rate (HR) during dobutamine stress echocardiography (DSE).

Background

In DSE, optimal accuracy is achieved when a target HR of 85% of maximal predicted heart rate (MPHR) is attained. Although rarely studied, intravenous isoproterenol has been used as an adjunct therapy to dobutamine and atropine to increase chronotropic response during pharmacologic stress testing.

Methods

We identified 5569 DSE studies during which 264 received isoproterenol at MedStar Georgetown University Hospital from August 2011 to March 2023. Of the studies receiving isoproterenol, we collected clinical and echocardiographic parameters from each study to assess the effects of isoproterenol administration, including downstream events.

Results

In 264 examinations with isoproterenol, 169 (64%) achieved 85% MPHR. Among these, 103 (39%) developed premature ventricular contractions, 79 (30%) developed symptoms including nausea/vomiting in 44 (17%), and chest pain in 15 (6%). There was a hypertensive response to stress in 53 studies (20%) and a hypotensive response in 37 studies (14%). There was no significant increase in 30-day and 1-year death when compared to studies that did not receive isoproterenol.

Conclusions

Isoproterenol can effectively be used as an adjunctive agent in DSE to achieve the requisite hemodynamic stress for evaluation of ischemia, with a similar rate of side effects and complications compared to dobutamine and atropine stress testing.

查看原文本刊更多论文

在多巴酚丁胺应激超声心动图中应用异丙托品醇的效果

目的：本研究评价异丙肾上腺素作为多巴酚丁胺应激超声心动图（DSE）中达到目标心率（HR）的辅助手段的安全性和有效性。背景：在DSE中，当目标心率达到最大预测心率（MPHR）的85%时，达到最佳准确率。尽管很少研究，静脉注射异丙肾上腺素已被用作多巴酚丁胺和阿托品的辅助治疗，以增加药物应激试验中的变时反应。方法：我们确定了5569例DSE研究，其中264例于2011年8月至2023年3月在MedStar Georgetown University Hospital接受异丙肾上腺素治疗。在接受异丙肾上腺素治疗的研究中，我们收集了每项研究的临床和超声心动图参数，以评估异丙肾上腺素治疗的影响，包括下游事件。结果：264例异丙肾上腺素检查中，169例（64%）达到85%的MPHR。其中103例（39%）出现室性早搏，79例（30%）出现恶心/呕吐等症状，44例（17%）出现恶心/呕吐，15例（6%）出现胸痛。53项研究（20%）出现应激反应导致高血压，37项研究（14%）出现低血压反应。与未使用异丙肾上腺素的研究相比，30天和1年的死亡率没有显著增加。结论：异丙肾上腺素可作为辅助药物有效地用于DSE，以获得评估缺血所需的血流动力学应激，与多巴酚丁胺和阿托品应激试验相比，其副作用和并发症发生率相似。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques 医学-心血管系统

CiteScore

2.40

自引率

6.70%

发文量

211

审稿时长

3-6 weeks

期刊介绍： Echocardiography: A Journal of Cardiovascular Ultrasound and Allied Techniques is the official publication of the International Society of Cardiovascular Ultrasound. Widely recognized for its comprehensive peer-reviewed articles, case studies, original research, and reviews by international authors. Echocardiography keeps its readership of echocardiographers, ultrasound specialists, and cardiologists well informed of the latest developments in the field.