Adverse effects of dobutamine stress echocardiography

OBJECTIVES: To study the side effects of dobutamine echocardiography and to define the protocol with less side effects. PATIENTS AND METHODS: Since June 1992 to November 1994 dobutamine echocardiography was performed on two different groups of patients. In the first, the test was preoperatively done to evaluate the surgical risk. The remaining were patients with angina. Dobutamine was started at a dose of 5 micrograms/kg/min and increased up to a total dose of 40 micrograms/kg/min. Since March 1993 atropine was added if the heart rate was under 90 beats/min. RESULTS: One hundred and forty one patients were included (76 for a preoperatory appraisal and 65 with angina). Echocardiography test was not performed on 3 patients (2 with pulmonary disease and 1 with a therapeutic neumothorax). Among the remaining 138 patients, side effects appeared in 53 patients (38%) and test had to be prematurely interrupted in 11 (8%) of them. Side effects presented during the test in 9 (7%) although it could be finished and at the end of the test in 33 (24%). The most frequent side effects were arrhythmias that appeared in 28 patients (20%) and were considered significant in 17: 7 with supraventricular tachycardia, 7 with more than 6 ventricular premature systoles per minute, 2 with ventricular tachycardia and 1 with multifocal supraventricular premature systoles. These arrhythmias were observed when the dose of dobutamine was 20 micrograms/kg/min or more (p < 0.05). Hypotension developed in 11 patients (8%) and noncardiac effects in 13 (9%). The dobutamine test was interrupted for arrhythmias in 4% of cases, noncardiac side effects in 2% and poor image quality in 3%. A steady increment of heart rate 5 minutes after infusion of atropine was detected in 12 patients (maximal: 93 +/- 23 beats per minute; after five minutes: 94 +/- 19) and side effects were encountered in only one of these patients (hypotension). CONCLUSIONS: Intravenous administration of dobutamine during echocardiography can be finished in the majority of patients with good tolerance in spite of its side effects. Arrhythmias with dose over 20 micrograms/kg/min, poor image quality and chronotropic insufficiency are the most frequently encountered limitations.