Dobutamine stress echocardiography

Abstract

High-dose dobutamine is an appropriate choice for pharmacological stress echocardiography used in the detection of coronary artery disease, especially in patients with an inability to exercise or contraindications to exercise, or when there are resting images of borderline quality that may make the more technically difficult exercise stress echocardiography a challenging task. It is also appropriate in intermediate-risk patients undergoing elective high-risk noncardiac surgery. Low-dose dobutamine is the first choice for identification of myocardial viability in patients with severe left ventricular dysfunction. It is also appropriate in low-flow, low-gradient aortic stenosis to separate true from pseudosevere aortic stenosis. Its appropriateness is unclear in intermediate-risk patients undergoing intermediate-risk noncardiac surgery. Patients with a history of complex atrial (paroxysmal atrial fibrillation, paroxysmal supraventricular tachycardia) or ventricular arrhythmias (sustained ventricular tachycardia or ventricular fibrillation) or with moderate to severe hypertension should probably not undergo dobutamine stress testing and be referred to safer vasodilator stress. © 2009 Springer Berlin Heidelberg.