Dobutamine Stress Testing in the Cardiac Catheterization Laboratory

Stress testing is often needed to assess the physiologic significance of coronary artery lesions, but there are no reliable stress tests widely available at the time of angiography. Rapid atrial pacing can be performed in the cardiac catheterization laboratory,[ 1 Sowton GE Balcon R Cross D Frick MH Measurement of the angina threshold using atrial pacing. Cardiovasc Res. 1967; 1: 301-307 Crossref PubMed Scopus (126) Google Scholar , 2 Linhart JW Hildner FJ Barold SS Lister JW Samet P Left heart hemodynamics during angina pectoris induced by atrial pacing. Circulation. 1969; 40: 483-492 Crossref PubMed Scopus (75) Google Scholar , 3 Helfant RH Forrester JS Hampton JR Haft JI Kemp HG Gorlin R Coronary heart disease. Differential hemodynamic, metabolic, and electrocardiographic effects in subjects with and without angina pectoris during atrial pacing. Circulation. 1970; 42: 601-610 Crossref PubMed Scopus (62) Google Scholar ]but it is less sensitive than exercise for the detection of myocardial ischemia.[ 4 Heller GV Aroesty JM McKay RG Parker JA Silverman KJ Come PC Grossman W The pacing stress test: A reexamination of the relation between coronary artery disease and pacing induced electrocardiographic changes. Am J Cardiol. 1984; 54: 50-55 Abstract Full Text PDF PubMed Scopus (35) Google Scholar ]The sensitivity of atrial pacing can be improved by the addition of thallium scintigraphy[ 4 Heller GV Aroesty JM McKay RG Parker JA Silverman KJ Come PC Grossman W The pacing stress test: A reexamination of the relation between coronary artery disease and pacing induced electrocardiographic changes. Am J Cardiol. 1984; 54: 50-55 Abstract Full Text PDF PubMed Scopus (35) Google Scholar , 5 Heller GV Aroesty JM Parker JA McKay RG Silverman KJ Als AV Come PC Kolodny GM Grossman W The pacing stress test: thallium-201 myocardial imaging after atrial pacing. J Am Coll Cardiol. 1984; 3: 1197-1204 Abstract Full Text PDF PubMed Scopus (31) Google Scholar ]or by measurement of metabolic markers of ischemia[ 3 Helfant RH Forrester JS Hampton JR Haft JI Kemp HG Gorlin R Coronary heart disease. Differential hemodynamic, metabolic, and electrocardiographic effects in subjects with and without angina pectoris during atrial pacing. Circulation. 1970; 42: 601-610 Crossref PubMed Scopus (62) Google Scholar , 6 Parker JO Chiong MA West RO Case RB Sequential alterations in myocardial lactate metabolism, S-T segments, and and left ventricular function during angina induced by atrial pacing. Circulation. 1969; 40: 113-131 Crossref PubMed Scopus (169) Google Scholar , 7 Sedlis SP Sequeira JM Altszuler HM Coronary sinus lysophosphatidylcholine accumulation during rapid atrial pacing. Am J Cardiol. 1990; 66: 695-698 Abstract Full Text PDF PubMed Scopus (35) Google Scholar ]; however, this is not practical for routine diagnostic use. Dobutamine infusion resembles exercise more than does rapid atrial pacing, because pacing does not increase blood pressure and causes only minimal elevations in plasma catecholamines.[ 8 Schwartz L Sole MJ Vaughn-Neil EF Hussain NM Catecholamines in coronary sinus and peripheral plasma during pacing-induced angina in man. Circulation. 1979; 59: 37-43 Crossref PubMed Scopus (43) Google Scholar ]Because dobutamine stress echo has been validated as an alternative to exercise,[ 9 Cohen JL Ottenweller JE George AK Duvvri S Comparison of dobutamine and exercise echocardiography for detecting coronary artery disease. Am J Cardiol. 1993; 72: 1226-1231 Abstract Full Text PDF PubMed Scopus (79) Google Scholar ]we sought to determine whether dobutamine infusion with evaluation of wall motion by contrast ventriculography could be used as a means of evaluating the significance of coronary stenoses at the time of cardiac catheterization and coronary angiography.