Dobutamine stress echocardiography

Abstract

Among exercise-independent stresses, the most popular are dobutamine and dipyridamole. Dobutamine is the prototype of pharmacological adrenergic or inotropic stress. It was initially proposed for the diagnosis of coronary artery disease in combination with perfusion imaging [1] and later with two-dimensional (2D) echocardiography by the Liege group [2]. Other sympathomimetic agents have been proposed for stress echocardiography, including isoproterenol [3] and epinephrine [4], but these drugs often bring more pronounced arrhythmogenic side effects. Following the demonstration of low-dose dobutamine as a test of myocardial viability in 1990 [5], in the subsequent decade dobutamine has been extensively adopted in pharmacological stress echocardiography. The evolution of dobutamine stress paralleled that of other pharmacological stresses. With echocardiography, it began at relatively “low” doses (20μg kg-1 min-1), which gave low sensitivity values [6]; later, more aggressive doses were adopted (up to 40μg kg-1 min-1) [7, 8], and finally it was coadministered with atropine [9], which overcame the limitation of less than ideal sensitivity to minor forms of coronary artery disease.