Key result
History of systemic hypertension independently predicted cumulative adverse effects during dobutamine stress echocardiography (OR 1.8; 95% CI 1.1-2.8; P=0.0138), but not during dipyridamole stress.
Why the study?
Does a history of hypertension affect the safety and feasibility of dobutamine and dipyridamole stress echocardiography?
Cohort (n=2,200)
No
Does a history of hypertension affect the safety and feasibility of dobutamine and dipyridamole stress echocardiography?
Dipyridamole stress echocardiography has a better safety profile and higher feasibility than dobutamine, particularly in hypertensive patients where hypertension independently predicts adverse effects during dobutamine stress.
Answers are grounded in this paper and cite their sources.
May support preferring dipyridamole over dobutamine stress echocardiography in hypertensives; this Level 3 cohort finding leaves open randomized confirmation.
OBJECTIVES: To establish whether safety and feasibility of dobutamine and dipyridamole stress echocardiography are affected by history of hypertension. METHODS: Data on 2200 consecutive pharmacologic stress echocardiography (959 dobutamine and 1241 dipyridamole) performed between October 1990 and February 2001 at a single cardiology centre, were analysed. RESULTS: There were two complications (1/480 tests) during dobutamine (one sustained ventricular tachycardia and one severe asthmatic attack following antidote administration) and two (1/620 tests) during dipyridamole (one non-Q wave myocardial infarction and one sustained ventricular tachycardia) stress. Complications or limiting side effects were observed in 83/959 patients (48/430 hypertensives and 35/529 normotensives) with dobutamine and in 34/1241 patients (17/571 hypertensives and 17/670 normotensives) with dipyridamole stress. Therefore, the overall feasibility was 88.8% in hypertensives and 93.4% in normotensives (P = 0.013) for dobutamine, and 97% in hypertensives and 97.5% in normotensives (P = 0.64) for dipyridamole. Dipyridamole was significantly more feasible than dobutamine in both hypertensive (P < 0.0001) and normotensive (P = 0.0006) subjects. Logistic regression analysis failed to identify clinical or echocardiographic predictors of adverse reactions with dipyridamole, while history of hypertension [odds ratio (OR) = 1.8, 95% confidence interval (CI) 1.1-2.8, P = 0.0138] was the only independent predictor of cumulative adverse reactions with dobutamine stress. In addition, history of hypertension (OR = 3.2, 95% CI, 1.2-8.5, P = 0.0166), resting wall motion abnormalities (OR = 1.8, 95% CI, 1.1-3.1, P = 0.0282), and age over 70 years (OR = 4.8, 95% CI, 1.5-15.3, P = 0.0087) predicted hypertensive response, ventricular tachycardia, and atrial fibrillation, respectively. No covariate was associated with hypotensive response during dobutamine test. CONCLUSIONS: Dipyridamole has a slightly better safety profile and significantly higher feasibility than dobutamine stress both in hypertensives and in normotensives. In addition, the history of systemic hypertension is an independent predictor of cumulative adverse effects during dobutamine but not during dipyridamole stress.
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Cortigiani et al. (2002) conducted a cohort in Indication for stress echocardiography (n=2,200). History of hypertension vs. Normotension was evaluated on Cumulative adverse reactions during dobutamine stress (OR 1.8, 95% CI 1.1-2.8, p=0.0138). History of systemic hypertension independently predicted cumulative adverse effects during dobutamine stress echocardiography (OR 1.8; 95% CI 1.1-2.8; P=0.0138), but not during dipyridamole stress.
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