(Circulation. 1997;96:2353-2360.)
© 1997 American Heart Association, Inc.
Articles |
Effects of Dobutamine Stress on Myocardial Blood Flow, 99mTc Sestamibi Uptake, and Systolic Wall Thickening in the Presence of Coronary Artery Stenoses
Implications for Dobutamine Stress Testing
From the Experimental Cardiology Laboratory, Cardiovascular Division, Department of Medicine, University of Virginia Health Sciences Center, Charlottesville.
Background Although dobutamine stress is used with both 99mTc sestamibi (sestamibi) myocardial perfusion imaging and echocardiography for detecting coronary artery stenoses, the impact of stenosis severity on test end points (myocardial sestamibi uptake and systolic thickening, respectively) has not been clearly defined.
Methods and Results In 15 open-chest dogs,
dobutamine (2.5 to 30 µg ·
kg-1 · min-1)
was infused after placement of an LAD stenosis that reduced
(n=8) or abolished (n=7) flow reserve. In dogs with reduced flow
reserve, the stenotic-to-normal sestamibi activity ratio
(0.86±0.03) significantly underestimated the 
2-to-1
dobutamine-induced flow disparity at the time of sestamibi
injection (flow ratio, 0.53±0.04; P<.001).
Stenotic-zone thickening increased at low but not at higher
doses of dobutamine (2.9±0.4 versus 4.2±0.4 mm in
normal zone at peak dobutamine; P=.055) but did
not fall below baseline (2.7±0.3 mm). Similarly, in dogs with
absent flow reserve, the sestamibi activity ratio (0.78±0.02)
underestimated the 2.5-to-1 dobutamine-induced flow
disparity (flow ratio, 0.41±0.05; P<.001), and failure to
increase systolic thickening was observed in the
stenotic zone (2.7±0.4 versus 4.6±0.3 mm in the normal
zone at peak stress, P<.01). In both groups of dogs,
myocardial sestamibi uptake and image defect magnitudes were less than
expected for the dobutamine-induced hyperemia,
suggesting that dobutamine adversely affects myocardial
sestamibi binding. Finally, a significant reduction in
stenotic-zone thickening was seen during
postdobutamine recovery, consistent with myocardial
stunning.
Conclusions In the presence of stenoses that reduced or abolished regional flow reserve, (1) myocardial sestamibi uptake significantly underestimated the dobutamine-induced flow heterogeneity, (2) a "failure to increase systolic thickening" rather than a reduction in thickening was observed during dobutamine stress, and (3) myocardial stunning was observed during postdobutamine recovery.
Key Words: imaging • inotropic agents • radioisotopes • stunning, myocardial
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