(Circulation. 1997;96:3346-3352.)
© 1997 American Heart Association, Inc.
Articles |
Effects of Dobutamine at Maximally Tolerated Dose on Myocardial Blood Flow in Humans With Ischemic Heart Disease
From the Departments of Medicine (Cardiac Unit), Radiology, and Nuclear Medicine, Massachusetts General Hospital, Harvard Medical School, Boston.
Correspondence to Henry Gewirtz, MD, Cardiac Unit/Vincent Burnham 3, Massachusetts General Hospital, Boston, MA 02114. E-mail gewirtz.henry{at}mgh.harvard.edu
Background This study tests the hypothesis in humans with ischemic heart disease that myocardial blood flow response to dobutamine is linearly correlated with blood flow response to adenosine.
Methods and Results PET with [13N]ammonia was
used to measure myocardial blood flow at rest and during
adenosine and dobutamine at the maximally tolerated
dose. Myocardial segments were defined
physiologically on the basis of blood flow
response to adenosine: normal, 
2 mL ·
min-1 · g-1;
abnormal, <2 mL · min-1 ·
g-1; and "steal," decline versus
baseline 0.15 mL · min-1 ·
g-1. The patient population consisted of 11
men and 2 women. Dobutamine increased heart rate (79±22 to
115±28 bpm) and rate-pressure product (9748±2862 to
15 157±3433 mm Hg/min) significantly (both P<.01).
Myocardial blood flow at rest in abnormal segments (0.50±0.23 mL
· min-1 ·
g-1) was reduced (P<.001) versus
normal (0.90±0.45) and steal (0.92±0.60). Nevertheless, in abnormal
segments, blood flow increased versus rest (P<.001) with
dobutamine (0.83±0.43) and adenosine (0.90±0.49).
In steal segments, myocardial blood flow declined versus baseline
(P<.001) with dobutamine (0.68±0.46) and
adenosine (0.50±0.45). In normal segments, myocardial blood
flow increased (P<.001) with dobutamine
(2.16±0.99) and adenosine (3.10±0.90). Over the range of
flows, the correlation between adenosine and
dobutamine was good (r=.78,
P<.0001). Although flow with dobutamine in
normal segments correlated with rate-pressure product
(r=.81, P<.05), the slope of the line was
2.7±0.8 (P<.02), and normalized blood flow (3.3±2.5
xrest) exceeded normalized rate-pressure product (1.9±0.8 xrest;
P<.05).
Conclusions In humans with ischemic heart disease, myocardial blood flow responses to dobutamine and adenosine are linearly correlated over a wide range. The hyperemic response to dobutamine is in excess of that predicted by rate-pressure product and reflects the unmeasured inotropic, oxygen-wasting, and ß2-agonist effects of the drug. Dobutamine induces coronary steal with a frequency approaching that of adenosine.
Key Words: dobutamine • blood flow • ischemia
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