Typical blood pressure response during dobutamine stress echocardiography of patients without known cardiovascular disease who have normal stress echocardiograms

Abstract

Aims: Blood pressure (BP) responses during dobutamine stress echocardiography (DSE) have not been systematically studied. Consequently, it is not known what constitutes a normal or an abnormal BP response to dobutamine stress. We sought to define the typical BP response during DSE of patients not known to have cardiovascular disease.

Methods and results: Of 24 134 patients who underwent DSE from November 2003 to December 2012 at Mayo Clinic, Rochester, MN, 2968 were selected for inclusion in this retrospective study. Excluded were patients with a history of hypertension, diabetes, or coronary artery disease, and those taking vasoactive medications. Patients who had baseline and/or stress-induced wall motion abnormalities were also excluded. The distribution of the study population's BP responses during DSE was Gaussian; we defined cut-point values for normative BP responses at 2 SD for each decade of age and for the whole study population. During DSE, systolic BP (SBP) increased from baseline to peak stress (Δ +2.9 ± 24 mmHg, P < 0.0001) and diastolic BP (DBP) decreased (Δ -7.4 ± 14 mmHg). BP changes were age and sex dependent; men and younger patients had greater ΔSBP and lesser ΔDBP, compared with women and older patients. Patients who received atropine had higher peak BP values than patients who did not receive atropine, due to greater ΔSBP (+7.4 ± 26 vs. -0.5 ± 22 mmHg, P < 0.0001) and lesser ΔDBP (-4 ± 14 vs. -9.7 ± 12 mmHg, P < 0.0001). This atropine effect was present in men and women, and was more pronounced in younger patients. The normative peak SBP values ranged from 82 to 182 mmHg.

Conclusion: BP responses during DSE vary and depend on patients' age, gender, and the use of atropine. We describe the typical BP responses seen during DSE and report normative reference values, which can be used for defining normal and abnormal BP responses to dobutamine stress.

Keywords: atropine; blood pressure; dobutamine stress echocardiography.

Figure 1

Blood pressure response during DSE, by age and the use of atropine. ΔSBP was higher and ΔDBP was lower in patients who received atropine, compared with patients who did not. BP values were higher in younger patients. Data presented as mean value ± 1 SD. ΔDBP, change in diastolic blood pressure; ΔSBP, change in systolic blood pressure.

Figure 2

Blood pressure and HR responses in patients who received a dobutamine dose of 40 µg/kg/min, by the use of atropine. Changes from baseline, during each dobutamine stage. Data presented as mean value ± 1 SD. ΔDBP, change in diastolic blood pressure; ΔSBP, change in systolic blood pressure; HR, heart rate.