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  • Title: Dobutamine stress: effects on regional myocardial blood flow and wall motion.
    Author: Severi S, Underwood R, Mohiaddin RH, Boyd H, Paterni M, Camici PG.
    Journal: J Am Coll Cardiol; 1995 Nov 01; 26(5):1187-95. PubMed ID: 7594031.
    Abstract:
    OBJECTIVES: This investigation studied the relation between regional myocardial blood flow and left ventricular function during dobutamine stress in patients with coronary artery disease. BACKGROUND: Dobutamine stress is becoming more frequently used as an alternative to dynamic exercise in patients with ischemic heart disease. METHODS: We studied 12 patients with coronary artery disease. Dobutamine was infused from 5 micrograms/kg body weight per min up to 40 micrograms/kg per min or until chest pain or other intolerable side effects. Regional myocardial blood flow was measured with positron emission tomography and oxygen-15-labeled water. Regional wall motion was assessed in three short-axis slices by magnetic resonance imaging. Each slice was subdivided into four regions: septal, anterior, lateral and inferior. A total of 140 regions were suitable for comparison. RESULTS: During stress, new wall motion abnormalities developed in 27 regions. Myocardial blood flow (mean +/- SD) increased in 113 regions that did not develop wall motion abnormalities (0.98 +/- 0.26 [baseline] vs. 1.98 +/- 0.87 [dobutamine] ml/min per g, p < 0.001), whereas it did not change significantly in regions with stress-induced wall motion abnormalities (1.00 +/- 0.28 [baseline] vs. 1.30 +/- 0.62 [dobutamine] ml/min per g, p = NS). An absolute decrease in myocardial blood flow below the value at rest was observed in seven segments that developed wall motion abnormalities during stress. CONCLUSIONS: The normal functional response to dobutamine stress is paralleled by an increase in coronary flow, whereas mechanical dysfunction is accompanied by a blunted increase, or even a paradoxic decrease, in regional coronary flow.
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