Impact of Various Doses of Dobutamine on Myocardial Viability and the Effects of β-Blockers in Patients With Ischemic Cardiomyopathy: An Assessment Using Stress Echocardiography

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques Pub Date : 2025-03-28 DOI:10.1111/echo.70134

Li Li, Zhiming Jiang, Liangyi Li, Na Yi, Linlin Chen, Linzi Li

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引用次数: 0

Abstract

Background

This study aimed to investigate the predictive value of dobutamine stress echocardiography (DSE) at varying doses for myocardial viability, with a particular emphasis on the impact of β-adrenergic blockers on myocardial viability in patients with ischemic cardiomyopathy (ICM).

Material and Methods

A total of 189 patients with ICM underwent DSE. Based on the dosage of dobutamine, patients were randomly divided into three groups: low-dose group (LD, 10 µg/kg/min, n = 63), medium-dose group (CD, 20 µg/kg/min, n = 63), and high-dose group (HD, 30 µg/kg/min, n = 63). All patients received β-blockers 1 min after the DSE examination. Changes in heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), radial strain (RS), and radial strain rate (RSr) during left ventricular systole (LVS) were analyzed, along with secondary effects and myocardial viability in the LD-β, CD-β, and HD-β groups.

Results

During the postoperative dobutamine injection, HR, SBP, and DBP in the LD, CD, and HD groups were significantly higher compared to pre-injection levels (p < 0.05), with DBP in the HD group being notably higher than in the LD and CD groups (p < 0.05). After intravenous injection of metoprolol, all indicators significantly decreased in the LD and CD groups (p < 0.05). The rates of RS and RSr in the CD and HD groups were significantly lower than those in the LD group (p < 0.05). The proportion of normal wall motion viability (VWM) post-injection was significantly higher than pre-injection levels (p < 0.05), with the CD group surpassing the LD group (p < 0.05). The use of β-adrenergic blockers demonstrated that the sensitivity, specificity, and accuracy of myocardial viability in the LD, CD, and HD groups were all superior to those of the control group (p < 0.05), with the CD group exhibiting the highest diagnostic performance (p < 0.05). The incidence of arrhythmias in the HD group was 20.3%, compared to 7.9% in the LD group (χ² = 6.78, p = 0.034). Additionally, the occurrence of cardiovascular events in the HD group was 17.2%, significantly higher than the 6.3% observed in the LD group (χ² = 6.21, p = 0.045).

Conclusion

Moderate-dose DSE exhibited the optimal diagnostic performance in assessing myocardial viability in patients with ICM. Furthermore, the use of β-blockers effectively enhances the sensitivity and accuracy of the diagnosis, providing important practical guidance for the clinical evaluation of myocardial viability.

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不同剂量多巴酚丁胺对缺血性心肌病患者心肌活力的影响及β受体阻滞剂的作用：应激超声心动图评估

背景本研究旨在探讨不同剂量的多巴酚丁胺应激超声心动图（DSE）对心肌活力的预测价值，尤其是β肾上腺素能阻滞剂对缺血性心肌病（ICM）患者心肌活力的影响。材料与方法共有 189 名 ICM 患者接受了 DSE。根据多巴酚丁胺的剂量，患者被随机分为三组：低剂量组（LD，10 µg/kg/min，n = 63）、中剂量组（CD，20 µg/kg/min，n = 63）和高剂量组（HD，30 µg/kg/min，n = 63）。所有患者都在 DSE 检查后 1 分钟接受了 β 受体阻滞剂治疗。分析了 LD-β、CD-β 和 HD-β 组在左心室收缩期（LVS）的心率（HR）、收缩压（SBP）、舒张压（DBP）、径向应变（RS）和径向应变率（RSr）的变化，以及继发效应和心肌活力。结果术后注射多巴酚丁胺期间，LD 组、CD 组和 HD 组的 HR、SBP 和 DBP 与注射前相比明显升高（p < 0.05），其中 HD 组的 DBP 明显高于 LD 组和 CD 组（p < 0.05）。静脉注射美托洛尔后，LD 组和 CD 组的所有指标均明显下降（p < 0.05）。CD 组和 HD 组的 RS 和 RSr 率明显低于 LD 组（p < 0.05）。注射后室壁运动存活率（VWM）正常的比例明显高于注射前水平（p <0.05），其中 CD 组高于 LD 组（p <0.05）。β肾上腺素能阻滞剂的使用表明，LD、CD 和 HD 组心肌活力的敏感性、特异性和准确性均优于对照组（p < 0.05），其中 CD 组的诊断性能最高（p < 0.05）。HD 组的心律失常发生率为 20.3%，而 LD 组为 7.9%（χ2 = 6.78，p = 0.034）。此外，HD 组的心血管事件发生率为 17.2%，明显高于 LD 组的 6.3%（χ2 = 6.21，P = 0.045）。结论中等剂量 DSE 在评估 ICM 患者心肌存活能力方面具有最佳诊断性能。此外，使用 β 受体阻滞剂可有效提高诊断的敏感性和准确性，为临床评估心肌活力提供重要的实用指导。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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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.