Safety and feasibility of dobutamine and dipyridamole stress echocardiography in hypertensive patients

Lauro Cortigiani, Luigi Zanetti, Riccardo Bigi, Alessandro Desideri, Cesare Fiorentini, Eugenio Nannini

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Objectives: To establish whether safety and feasibility of dobutamine and dipyridamole stress echocardiography are affected by history of hypertension. Methods: Data on 2200 consecutive pharmacologic stress echocardiography (959 dobutamine and 1241 dipyridamole) performed between October 1990 and February 2001 at a single cardiology centre, were analysed. Results: There were two complications (1/480 tests) during dobutamine (one sustained ventricular tachycardia and one severe asthmatic attack following antidote administration) and two (1/620 tests) during dipyridamole (one non-Q wave myocardial infarction and one sustained ventricular tachycardia) stress. Complications or limiting side effects were observed in 83/959 patients (48/430 hypertensives and 35/529 normotensives) with dobutamine and in 34/1241 patients (17/571 hypertensives and 17/670 normotensives) with dipyridamole stress. Therefore, the overall feasibility was 88.8% in hypertensives and 93.4% in normotensives (P = 0.013) for dobutamine, and 97% in hypertensives and 97.5% in normotensives (P = 0.64) for dipyridamole. Dipyridamole was significantly more feasible than dobutamine in both hypertensive (P <0.0001) and normotensive (P = 0.0006) subjects. Logistic regression analysis failed to identify clinical or echocardiographic predictors of adverse reactions with dipyridamole, while history of hypertension [odds ratio (OR) = 1.8, 95% confidence interval (CI) 1.1 - 2.8, P = 0.0138] was the only independent predictor of cumulative adverse reactions with dobutamine stress. In addition, history of hypertension (OR = 3.2, 95% CI, 1.2-8.5, P = 0.0166), resting wall motion abnormalities (OR = 1.8, 95% CI, 1.1-3,1, P = 0.0282), and age over 70 years (OR = 4.8, 95% CI, 1.5-15.3, P = 0.0087) predicted hypertensive response, ventricular tachycardia, and atrial fibrillation, respectively. No covariate was associated with hypotensive response during dobutamine test. Conclusions: Dipyridamole has a slightly better safety profile and significantly higher feasibility than dobutamine stress both in hypertensives and in normotensives. In addition, the history of systemic hypertension is an independent predictor of cumulative adverse effects during dobutamine but not during dipyridamole stress.

Original languageEnglish
Pages (from-to)1423-1429
Number of pages7
JournalJournal of Hypertension
Volume20
Issue number7
DOIs
Publication statusPublished - Jul 2002

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Stress Echocardiography
Dipyridamole
Dobutamine
Safety
Ventricular Tachycardia
Odds Ratio
Confidence Intervals
Hypertension
Antidotes
Ventricular Fibrillation
Cardiology
Atrial Fibrillation
Logistic Models
History
Myocardial Infarction
Regression Analysis

Keywords

  • Coronary artery disease
  • Dipyridamole
  • Dobutamine
  • Hypertension
  • Stress echocardiography

ASJC Scopus subject areas

  • Endocrinology
  • Internal Medicine

Cite this

Safety and feasibility of dobutamine and dipyridamole stress echocardiography in hypertensive patients. / Cortigiani, Lauro; Zanetti, Luigi; Bigi, Riccardo; Desideri, Alessandro; Fiorentini, Cesare; Nannini, Eugenio.

In: Journal of Hypertension, Vol. 20, No. 7, 07.2002, p. 1423-1429.

Research output: Contribution to journalArticle

Cortigiani, Lauro ; Zanetti, Luigi ; Bigi, Riccardo ; Desideri, Alessandro ; Fiorentini, Cesare ; Nannini, Eugenio. / Safety and feasibility of dobutamine and dipyridamole stress echocardiography in hypertensive patients. In: Journal of Hypertension. 2002 ; Vol. 20, No. 7. pp. 1423-1429.
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abstract = "Objectives: To establish whether safety and feasibility of dobutamine and dipyridamole stress echocardiography are affected by history of hypertension. Methods: Data on 2200 consecutive pharmacologic stress echocardiography (959 dobutamine and 1241 dipyridamole) performed between October 1990 and February 2001 at a single cardiology centre, were analysed. Results: There were two complications (1/480 tests) during dobutamine (one sustained ventricular tachycardia and one severe asthmatic attack following antidote administration) and two (1/620 tests) during dipyridamole (one non-Q wave myocardial infarction and one sustained ventricular tachycardia) stress. Complications or limiting side effects were observed in 83/959 patients (48/430 hypertensives and 35/529 normotensives) with dobutamine and in 34/1241 patients (17/571 hypertensives and 17/670 normotensives) with dipyridamole stress. Therefore, the overall feasibility was 88.8{\%} in hypertensives and 93.4{\%} in normotensives (P = 0.013) for dobutamine, and 97{\%} in hypertensives and 97.5{\%} in normotensives (P = 0.64) for dipyridamole. Dipyridamole was significantly more feasible than dobutamine in both hypertensive (P <0.0001) and normotensive (P = 0.0006) subjects. Logistic regression analysis failed to identify clinical or echocardiographic predictors of adverse reactions with dipyridamole, while history of hypertension [odds ratio (OR) = 1.8, 95{\%} confidence interval (CI) 1.1 - 2.8, P = 0.0138] was the only independent predictor of cumulative adverse reactions with dobutamine stress. In addition, history of hypertension (OR = 3.2, 95{\%} CI, 1.2-8.5, P = 0.0166), resting wall motion abnormalities (OR = 1.8, 95{\%} CI, 1.1-3,1, P = 0.0282), and age over 70 years (OR = 4.8, 95{\%} CI, 1.5-15.3, P = 0.0087) predicted hypertensive response, ventricular tachycardia, and atrial fibrillation, respectively. No covariate was associated with hypotensive response during dobutamine test. Conclusions: Dipyridamole has a slightly better safety profile and significantly higher feasibility than dobutamine stress both in hypertensives and in normotensives. In addition, the history of systemic hypertension is an independent predictor of cumulative adverse effects during dobutamine but not during dipyridamole stress.",
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T1 - Safety and feasibility of dobutamine and dipyridamole stress echocardiography in hypertensive patients

AU - Cortigiani, Lauro

AU - Zanetti, Luigi

AU - Bigi, Riccardo

AU - Desideri, Alessandro

AU - Fiorentini, Cesare

AU - Nannini, Eugenio

PY - 2002/7

Y1 - 2002/7

N2 - Objectives: To establish whether safety and feasibility of dobutamine and dipyridamole stress echocardiography are affected by history of hypertension. Methods: Data on 2200 consecutive pharmacologic stress echocardiography (959 dobutamine and 1241 dipyridamole) performed between October 1990 and February 2001 at a single cardiology centre, were analysed. Results: There were two complications (1/480 tests) during dobutamine (one sustained ventricular tachycardia and one severe asthmatic attack following antidote administration) and two (1/620 tests) during dipyridamole (one non-Q wave myocardial infarction and one sustained ventricular tachycardia) stress. Complications or limiting side effects were observed in 83/959 patients (48/430 hypertensives and 35/529 normotensives) with dobutamine and in 34/1241 patients (17/571 hypertensives and 17/670 normotensives) with dipyridamole stress. Therefore, the overall feasibility was 88.8% in hypertensives and 93.4% in normotensives (P = 0.013) for dobutamine, and 97% in hypertensives and 97.5% in normotensives (P = 0.64) for dipyridamole. Dipyridamole was significantly more feasible than dobutamine in both hypertensive (P <0.0001) and normotensive (P = 0.0006) subjects. Logistic regression analysis failed to identify clinical or echocardiographic predictors of adverse reactions with dipyridamole, while history of hypertension [odds ratio (OR) = 1.8, 95% confidence interval (CI) 1.1 - 2.8, P = 0.0138] was the only independent predictor of cumulative adverse reactions with dobutamine stress. In addition, history of hypertension (OR = 3.2, 95% CI, 1.2-8.5, P = 0.0166), resting wall motion abnormalities (OR = 1.8, 95% CI, 1.1-3,1, P = 0.0282), and age over 70 years (OR = 4.8, 95% CI, 1.5-15.3, P = 0.0087) predicted hypertensive response, ventricular tachycardia, and atrial fibrillation, respectively. No covariate was associated with hypotensive response during dobutamine test. Conclusions: Dipyridamole has a slightly better safety profile and significantly higher feasibility than dobutamine stress both in hypertensives and in normotensives. In addition, the history of systemic hypertension is an independent predictor of cumulative adverse effects during dobutamine but not during dipyridamole stress.

AB - Objectives: To establish whether safety and feasibility of dobutamine and dipyridamole stress echocardiography are affected by history of hypertension. Methods: Data on 2200 consecutive pharmacologic stress echocardiography (959 dobutamine and 1241 dipyridamole) performed between October 1990 and February 2001 at a single cardiology centre, were analysed. Results: There were two complications (1/480 tests) during dobutamine (one sustained ventricular tachycardia and one severe asthmatic attack following antidote administration) and two (1/620 tests) during dipyridamole (one non-Q wave myocardial infarction and one sustained ventricular tachycardia) stress. Complications or limiting side effects were observed in 83/959 patients (48/430 hypertensives and 35/529 normotensives) with dobutamine and in 34/1241 patients (17/571 hypertensives and 17/670 normotensives) with dipyridamole stress. Therefore, the overall feasibility was 88.8% in hypertensives and 93.4% in normotensives (P = 0.013) for dobutamine, and 97% in hypertensives and 97.5% in normotensives (P = 0.64) for dipyridamole. Dipyridamole was significantly more feasible than dobutamine in both hypertensive (P <0.0001) and normotensive (P = 0.0006) subjects. Logistic regression analysis failed to identify clinical or echocardiographic predictors of adverse reactions with dipyridamole, while history of hypertension [odds ratio (OR) = 1.8, 95% confidence interval (CI) 1.1 - 2.8, P = 0.0138] was the only independent predictor of cumulative adverse reactions with dobutamine stress. In addition, history of hypertension (OR = 3.2, 95% CI, 1.2-8.5, P = 0.0166), resting wall motion abnormalities (OR = 1.8, 95% CI, 1.1-3,1, P = 0.0282), and age over 70 years (OR = 4.8, 95% CI, 1.5-15.3, P = 0.0087) predicted hypertensive response, ventricular tachycardia, and atrial fibrillation, respectively. No covariate was associated with hypotensive response during dobutamine test. Conclusions: Dipyridamole has a slightly better safety profile and significantly higher feasibility than dobutamine stress both in hypertensives and in normotensives. In addition, the history of systemic hypertension is an independent predictor of cumulative adverse effects during dobutamine but not during dipyridamole stress.

KW - Coronary artery disease

KW - Dipyridamole

KW - Dobutamine

KW - Hypertension

KW - Stress echocardiography

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