Key result
An accelerated dobutamine stress echocardiography protocol significantly reduced test duration (6 vs. 14 minutes) and total cumulative dobutamine dose compared to the standard protocol, with similar safety.
Why the study?
Because dobutamine steady-state concentration requires 10 minutes while standard DSE uses incremental 3-minute intervals, constant infusion of a higher dose was evaluated for safety and efficacy in CAD assessment.
Does an accelerated dobutamine stress echocardiography protocol reduce test duration and maintain safety compared to the standard protocol in patients assessed for coronary artery disease?
Case-Control (n=80)
Single-blind
No
Does an accelerated dobutamine stress echocardiography protocol reduce test duration and maintain safety compared to the standard protocol in patients assessed for coronary artery disease?
Absolute Event Rate: 6% vs 14%
p-value: p=<0.001
An accelerated dobutamine stress echocardiography protocol using a constant high-dose infusion is feasible, safe, and significantly reduces test duration and cumulative dobutamine dose compared to the standard protocol.
May shorten DSE duration with comparable safety in small matched cohort; leaves open confirmation of diagnostic accuracy versus standard protocol.
Objectives: The steady-state concentration of dobutamine at any infusion rate is not reached except after 10 min. Nevertheless, dobutamine stress echocardiography (DSE) still employs an incremental 3-min interval infusion protocol. Constant infusion of a higher dobutamine dose appears to overcome this pitfall. We aimed to evaluate the safety and efficacy of an accelerated DSE protocol for the assessment of coronary artery disease. Methods: From June 2018 to January 2019, forty consecutive patients underwent accelerated protocol for DSE (constant infusion of 50 μg/kg/min, with discontinuation of infusion at 10 min if no stress endpoint appears). Their hemodynamic responses and adverse effects' profile were compared to a control group (40 patients who underwent the standard protocol within the preceding 6 months). Results: Both groups were matched in all baseline characteristics. Peak heart rate (HR) (143 ± 13 vs. 145 ± 13 bpm, P = 0.54) and peak systolic blood pressure (160 ± 29 vs. 155 ± 42 mmHg, P = 0.53) were similar in both protocols. The accelerated protocol produced a significantly more rapid increase in HR (11.5 ± 2.3 vs. 5.3 ± 1.3 bpm, P< 0.001) and resulted in marked reduction in test duration (6 ± 2 vs. 14 ± 3 min, P < 0.001). The mean total cumulative dobutamine dose was lower in the accelerated group (275 ± 63 vs. 355 ± 144 μg/kg, P = 0.029). Both groups experienced similar rates of both arrhythmic and nonarrhythmic adverse effects. Conclusion: Accelerated DSE protocol seems as feasible, safe, effective, and more time-saving compared to the standard one. This might be of value to busy echocardiographic laboratories.
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Bendary et al. (2019) conducted a case-control in Coronary artery disease (n=80). Accelerated dobutamine stress echocardiography protocol vs. Standard dobutamine-atropine infusion protocol (3-min dose increments from 5 to 50 µg/kg/min) was evaluated on Test duration (minutes) (p=<0.001). An accelerated dobutamine stress echocardiography protocol significantly reduced test duration (6 vs. 14 minutes) and total cumulative dobutamine dose compared to the standard protocol, with similar safety.
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