Stress cardiomyopathy induced during dobutamine stress echocardiography

Amitoj Singh, Tudor Sturzoiu, Srilakshmi Vallabhaneni, Jamshid Shirani

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: Catecholamines play a central role in pathogenesis of stress cardiomyopathy (SC). We aimed to review the clinical characteristics, procedural details and outcomes of patients with SC during dobutamine stress echocardiography (DSE). Methods/Results: A total of 20 adults [age 64±15 years, 80% women, 67% hypertension, 20% diabetes, 33% hypercholesterolemia, 19% chronic kidney disease, 13% known anxiety disorder] with SC during DSE were identified from local digital archives of our laboratory (n=3) or reports in English literature (n=17). Indication for DSE was suspected coronary artery disease (CAD) in all patients. Left ventricular (LV) ejection fraction was normal at baseline. SC developed at a blood pressure of 154±47/86±24 mmHg, heart rate of 130±17 bpm (88±10% predicted maximum) and peak rate-pressure product of 20559±3898 mmHg∗bpm. ST segment elevation was seen in 65%. SC occurred at peak dobutamine infusion rate of 38±6 μg/kg/min in 85% and during recovery in 15%. Atropine [0.7±0.6 (0.25-2) mg] was given to 7 patients. LV ejection fraction dropped to 30±6% with apical (40%), apical and mid (45%) or basal and mid (10%) circumferential LV ballooning. One patient (5%) had a mixed pattern of wall motion abnormality. LV outflow tract obstruction developed in 15%. Major adverse cardiac events occurred in 7 (35%) and included death (n=1), congestive heart failure (n=2), hypotension (n=3) and atrial fibrillation with heart failure (n=1). At a mean follow up duration of 19±19 days, complete or partial recovery of LV wall motion abnormality was seen in 18 and 1 patient, respectively. Conclusion: SC uncommonly occurs during DSE. However, death and other adverse events (hypotension, heart failure and atrial fibrillation) may occur and require urgent attention. Once managed, complete recovery is expected in most patients.

Original languageEnglish (US)
Pages (from-to)S43-S48
JournalInternational Journal of Critical Illness and Injury Science
Volume10
Issue number5
DOIs
StatePublished - Sep 1 2020
Externally publishedYes

Keywords

  • Complications
  • dobutamine
  • dobutamine stress echocardiography
  • outcomes
  • stress cardiomyopathy
  • takotsubo

ASJC Scopus subject areas

  • Emergency Medicine
  • Public Health, Environmental and Occupational Health
  • Critical Care and Intensive Care Medicine

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