Effects of Isoproterenol Administration in Dobutamine Stress
Echocardiography
- Puja A. Patel,
- Zachary N. Parsia,
- Tsion Aberra,
- Nayrana Tillman,
- Martin Mathias,
- Adam Newell Bohn Johnson,
- Akanksha Girish,
- Brototo Deb,
- Carolina Valdiviezo,
- Christy Kaiser,
- Monvadi B. Srichai
Puja A. Patel
MedStar Georgetown University Hospital MedStar Washington Hospital Center Internal Medicine Residency Program
Author ProfileZachary N. Parsia
University of Virginia School of Engineering & Applied Science
Author ProfileNayrana Tillman
MedStar Georgetown University Hospital MedStar Washington Hospital Center Internal Medicine Residency Program
Author ProfileAdam Newell Bohn Johnson
Georgetown University School of Medicine
Author ProfileBrototo Deb
MedStar Georgetown University Hospital MedStar Washington Hospital Center Internal Medicine Residency Program
Author ProfileCarolina Valdiviezo
MedStar Georgetown University Hospital
Author ProfileAbstract
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Objective: This study evaluated the safety and efficacy of isoproterenol
administration as an adjunct for achievement of target heart rate during
dobutamine stress echocardiography (DSE). Background: In DSE, optimal
accuracy is achieved when a target heart rate of 85% of maximal
predicted heart rate (MPHR) is attained. Although rarely studied,
intravenous isoproterenol has been used as adjunct therapy to dobutamine
and atropine to increase chronotropic response during pharmacologic
stress testing. Methods: We identified 5569 DSE studies during which 264
received isoproterenol at MedStar Georgetown University Hospital from
August 2011- March 2023. Of the studies receiving isoproterenol, we
collected clinical and echocardiographic parameters from each study to
assess the effects of isoproterenol administration, including downstream
events. Results: In 264 examinations with isoproterenol, 169 (64%)
achieved 85% MPHR, 103 (39%) developed premature ventricular
contractions, 79 (30%) developed symptoms including nausea/vomiting in
44 (17%), and chest pain in 15 (6%). There was hypertensive response
to stress in 53 studies (20%) and hypotensive response in 37 studies
(14%). There was no significant increase in 30 day and 1 year death
when compared to studies that did not receive isoproterenol.
Conclusions: Isoproterenol can effectively be used as an adjunctive
agent in DSE to achieve the requisite hemodynamic stress for evaluation
of ischemia, with a similar rate of side effects and complications when
compared to dobutamine and atropine stress testing.19 Nov 2024Submitted to Echocardiography 22 Nov 2024Submission Checks Completed
22 Nov 2024Assigned to Editor
22 Nov 2024Review(s) Completed, Editorial Evaluation Pending
22 Nov 2024Reviewer(s) Assigned