Prognostic Significance of Systolic Blood Pressure Changes During Dobutamine-Atropine Stress Technetium-99m Sestamibi Perfusion Scintigraphy in Patients With Chest Pain and Known or Suspected Coronary Artery Disease
Section snippets
Patient Selection
Over a 4-year period, between November 1990 and October 1994, 418 consecutive patients with chest pain were referred to the nuclear cardiology laboratory at the Thoraxcentre for the evaluation of suspected myocardial ischemia with dobutamine-atropine technetium-99m sestamibi single-photon emission computed tomographic imaging. All patients were unable to perform an adequate exercise test and none had prior heart transplantation, significant congenital or valvular heart disease, unstable angina,
Dobutamine-Induced Decrease in Systolic Blood Pressure
A decrease in systolic BP ≥20 mm Hg was present in 65 patients (16%), and was associated with older age (p <0.001) and higher baseline systolic BP (p <0.0001). Severe, symptomatic hypotension as a test end point was present in only 4 patients (1%). Gender, history of prior myocardial infarction or congestive heart failure, and the use of β blockers, angiotensin-converting enzyme inhibitors or diuretics were not associated with a hypotensive systolic BP response (Table 1Table 2). There were no
Discussion
Generally, dobutamine stress causes an increase in heart rate, a reduction in systemic vascular resistance, a reduction in stroke volume (after an initial increase), and an increase in cardiac output.12, 19, 20Previous dobutamine stress studies have shown that as a net result, in general, there is a mild but significant increase in systolic BP.6, 21This would suggest that, on average, an increase in cardiac output corrects for the decrease in systemic vascular resistance. Although the
Acknowledgements
This study was supported in part by funds from the Dutch Heart Foundation (Grant NHS 94.135), The Hague, The Netherlands, and Cairo University Hospital, Cairo, Egypt.
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Prediction of mortality in heart transplant recipients by stress technetium-99m tetrofosmin myocardial perfusion imaging
2002, American Journal of CardiologyCitation Excerpt :Patients with subsequent cardiac death had a lower heart rate at stress and lower systolic blood pressure. The association between blood pressure response to exercise and cardiac events has been previously reported.7,8 In the multivariate analysis model, a lower rate-pressure product at peak stress was associated with an increased risk of cardiac death.
Dobutamine stress myocardial perfusion imaging
2000, Journal of the American College of CardiologyCitation Excerpt :Although angina occurs in approximately 25% of patients (7), severe angina as a test end point without accompanying reversible perfusion defects is rare. Dobutamine stress-induced hypotension (defined as a ≥20 mm Hg decrease in systolic blood pressure) occurs in approximately 15% of patients (5,7,61). Severe, symptomatic hypotension necessitating test termination, however, occurs only rarely.
Dobutamine-induced hypotension is an independent predictor for mortality in patients with left ventricular dysfunction following myocardial infarction
1999, International Journal of CardiologyImpaired systolic blood pressure response to dobutamine stress testing: A marker of more severe functional abnormalities in patients with myocardial infarction
1998, Journal of the American Society of EchocardiographyMethodology, feasibility, safety and diagnostic accuracy of dobutamine stress echocardiography
1997, Journal of the American College of Cardiology