Abstract
Background
Stress echocardiography (SE) plays important role in investigation of the patients with chest pain. Adverse events rate is higher in dobutamine stress echocardiography on comparison to dobutamine stress echocardiography (ExSE) or dipyridamole stress echocardiography (DIP). Dynamic stress (ExSE) is recommended as the first-choice method according to the current guidelines.
Purpose
Response to the different stressors was studied in several studies with controversial results. This study aimed to investigate myocardial injury during stress echocardiography measured by the serum high sensitivity troponin (hsTnT) in a low risk population and whether there is a difference in hsTnT response between various stressors.
Methods
135 patients (DSE n=46, ExsE n=46, Dip n=43) investigated for chest pain with suspicion on angina with negative diagnostic stress echocardiography were enrolled in the study. HsTnT was measured before and at 180 min. after the test was terminated. Patients with baseline elevated hsTnT levels (≥14 pg/ml), impaired LV EF (<50%), regional wall motion abnormalities, previous acute coronary syndrome and/or revascularisation, known epicardial coronary artery stenosis >50%, diabetes, prediabates (fasting glycemia at the day of the test ≥5,6 mmol/l, left ventricle hypertrophy >13 mm, baseline uncontrolled hypertension (BP >160/100 mmHg), estimated systolic pulmonary pressure >45 mmHg, more than moderate valvular disease, and patient who experienced dobutmine side effect (hypotension, atrial fibrillation) were excluded from the study.
Results
HsTnT increased in DSE and ExSE, but not in DIP group [9,4 (1,5–58,6), 1,1 (−0,9–15,7), −0,1 (−1,4–2,1) ng/L, p<0,001]. Similar result was found In DSE and ExSE subgroups without atropine [5,3 (0,4–45,3) vs 1,1 (−1,1–15,7) ng/L, p<0,001]. Adding atropine during SE triggered much greater hsTnT release in DSE [40,1 (3,7–160,3) vs 5,3 (0,4–45,3) ng/L, p<0,001], but not in ExSE group [0,6 (−0,9–22,7) vs 1,1 (−1,1–15,7) ng/L, p=0,786]. Moderate correlation of hsTnT rise with DSE length was observed (r=0,43).
Conclusions
DSE leads to significant myocardial injury multiplied when atropine is used. No injury was observed in DIP and only mild was revealed in ExSE. This finding support ExSE as the preferred stress echocardiography method. Whether significant myocardial injury is causative of the higher adverse event rates in DSE remains to be determined.
FUNDunding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): University Hospital Hradec Kralove, Czech RepublicFaculty of Medicine Hradec Kralove, Charles University, Czech Republic hsTnT change 0–180 min. the whole group hsTnT change 0–180 min. w/wo atropine
Comparison of early dobutamine stress echocardiography, exercise treadmill testing, and hospital admission for management of patients presenting to the emergency department with chest pain: a multicenter international randomized study
