MechanisMs of Hypotension During Dollu....ln. StreSS Ichocarcllography in Patients With Coronary Artery Disease

15 • 16 Hypotension during exercise stress indicates severe coronary artery disease, but hy­ potension during DSE is not an indicator of severity of coronary disease. 15 • 17 Reasons for hypotension during DSE have been attributed to dobutamine-induced cavi­ ty obliteration and vasovagal mechanisms, but the exact hemodynamic changes during hypotension are not known. This study investigates the precise hemodynamic mech­ anisms in terms of left ventricular (LV) systolic and dias­ tolic performance and peripheral changes responsible for hypotension during DSE in patients with angiographi­ cally documented coronary artery disease. METHODS Study patients: One hundred one consecutive patients undergoing DSE for clinical indications who had tech­ nically adequate echocardiograms and were in sinus rhythm were screened for the study. Of these patients, 67 had coronary angiography and 59 had significant coronary artery disease defined as ~70% diameter steno­ sis of an epicardial coronary artery or major branch ves­ sel. All were men with a mean age of 63 ± 8 years (range