Dobutamine Stress Echocardiography

Dobutamine stress echocardiography

Dobutamine stress echocardiography uses dobutamine instead of exercise, to stress the heart muscle. Dobutamine increases the heart rate as well as force of contraction of the heart muscle, thereby increasing its workload. Initial dobutamine infusion is at a low dose and followed by high dose dobutamine infusion. Ischemic, but viable myocardium will show improvement in wall motion at low dose dobutamine with worsening at high dose dobutamine infusion. There will be no such response for scarred myocardium which is non viable and it will show akinesia.
Wall motion scoring is graded as follows:

  1. Normally contracting segment: 1
  2. Hypokinetic segment: 2
  3. Akinetic segment: 3
  4. Dyskinetic segment: 4

Wall motion score index can be calculated as an average score of all the visualized segments.

Though dobutamine stress echocardiography is an excellent evaluation tool, especially in those who cannot do exercise, it is quite cumbersome in an echo room with limited space for resuscitation equipment. This has limited its practical utilization in spite of lot of studies documenting its benefit. Time needed is another issue if there is only one echo room with high workload.

Ddobutamine stress echocardiography is used for workup of patients awaiting liver transplant as they are unfit for exercise stress test. Coronary angiography is also risky in them because of increased bleeding risk secondary to liver disease.

Reference

  1. Snipelisky D, Levy M, Shapiro B. Utility of dobutamine stress echocardiography as part of the pre-liver transplant evaluation: an evaluation of its efficacy. Clin Cardiol. 2014 Aug;37(8):468-72.