Objectives: The steady‑state concentration of dobutamine at any infusion rate is not reached except after 10 min. Nevertheless, dobutamine
stress echocardiography (DSE) still employs an incremental 3‑min interval infusion protocol. Constant infusion of a higher dobutamine dose
appears to overcome this pitfall. We aimed to evaluate the safety and efficacy of an accelerated DSE protocol for the assessment of coronary
artery disease. Methods: From June 2018 to January 2019, forty consecutive patients underwent accelerated protocol for DSE (constant infusion
of 50 μg/kg/min, with discontinuation of infusion at 10 min if no stress endpoint appears). Their hemodynamic responses and adverse effects’
profile were compared to a control group (40 patients who underwent the standard protocol within the preceding 6 months). Results: Both
groups were matched in all baseline characteristics. Peak heart rate (HR) (143 ± 13 vs. 145 ± 13 bpm, P = 0.54) and peak systolic blood
pressure (160 ± 29 vs. 155 ± 42 mmHg, P = 0.53) were similar in both protocols. The accelerated protocol produced a significantly more rapid
increase in HR (11.5 ± 2.3 vs. 5.3 ± 1.3 bpm, P < 0.001) and resulted in marked reduction in test duration (6 ± 2 vs. 14 ± 3 min, P < 0.001).
The mean total cumulative dobutamine dose was lower in the accelerated group (275 ± 63 vs. 355 ± 144 μg/kg, P = 0.029). Both groups
experienced similar rates of both arrhythmic and nonarrhythmic adverse effects. Conclusion: Accelerated DSE protocol seems as feasible,
safe, effective, and more time‑saving compared to the standard one. This might be of value to busy echocardiographic laboratories. |
