scholarly journals Safety and efficacy of physiologist-led dobutamine stress echocardiography: experience from a tertiary cardiac centre

2018 ◽  
Vol 5 (3) ◽  
pp. 105-112 ◽  
Author(s):  
Theodoros Ntoskas ◽  
Farhanda Ahmad ◽  
Paul Woodmansey
Keyword(s):  
Drug Administration ◽  
Stress Echocardiography ◽  
Dobutamine Stress Echocardiography ◽  
Dobutamine Stress ◽  
Medical Support ◽  
Safety And Efficacy ◽  
Intensive Training ◽  
Cardiac Centre ◽  
Artery Disease ◽  
Inducible Ischaemia

Background Dobutamine stress echocardiography (DSE) services have traditionally been medically led. In some UK institutions, DSE lists are led by physiologists with medical support. In our tertiary cardiac centre at New Cross Hospital (NCH), the DSE service was established by a consultant echocardiographer. Following intensive training and assessment, the Trust approved drug administration by named senior cardiac physiologists. We believe this is the first report of a cardiac physiologist-managed DSE service, including physiologist drug administration. We have assessed the feasibility, safety and validity of this physiologist-led DSE service. Methods Retrospective analysis of 333 patients undergoing stress echocardiogram for inducible reversible ischaemia, myocardial viability and valvular heart disease over 6 months. Patients’ case notes review after 18–24 months. Results Overall, 92% of all cases (306) were performed by physiologists. In 300 studies, dobutamine was administered. The majority of the referrals were for coronary artery disease (CAD) assessment (281). In 235 cases, the study was uncomplicated. Sixty-seven patients developed dobutamine-related side effects. In 16 cases, complications led to early termination of the study. In two cases, urgent medical review was needed. Of the 281 studies for CAD assessment, 239 were negative for ischaemia, 28 were positive and 14 inconclusive. In 5 out of 28 cases with echocardiogram, evidence of inducible ischaemia, coronary angiography revealed unobstructed coronary arteries. Conclusion This study demonstrates the safety and effectiveness of this practice and provides potential for the expansion of the physiologists’ role and physiologist-led DSE services in other hospitals.

Dobutamine Stress Echocardiography to Detect Inducible Demand Ischemia in Anesthetized Patients with Coronary Artery Disease 

1998 ◽  
Vol 88 (5) ◽  
pp. 1233-1239 ◽  
Author(s):  
Manfred D. Seeberger ◽  
Karl Skarvan ◽  
Peter Buser ◽  
Wolfgang Brett ◽  
Reinhard Rohlfs ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Stress Echocardiography ◽  
Dobutamine Stress Echocardiography ◽  
Dobutamine Stress ◽  
Noncardiac Surgery ◽  
Severe Coronary Artery Disease ◽  
Inducible Ischemia ◽  
Severe Coronary Artery ◽  
Artery Disease

Background A cardiac risk stratification test that can be performed during operation would be expected to give valuable information for the therapeutic management of patients who need urgent noncardiac surgery. This study was designed to evaluate the feasibility and safety of a dobutamine-atropine stress protocol to detect inducible demand ischemia in anesthetized patients. Methods A standard dobutamine-atropine stress protocol was performed in 80 patients with severe coronary artery disease during fentanyl-isoflurane anesthesia. Biplane transesophageal echocardiography and 12-lead electrocardiography were used to detect induced ischemia. After dobutamine testing, esmolol, nitroglycerin, or both were used to revert ischemia and any hemodynamic changes, as appropriate. Results The protocol detected inducible ischemia or achieved the target heart rate in 75 of the 80 (94%) patients. None of the prospectively defined adverse outcomes, such as cardiovascular collapse, severe ventricular arrhythmia, persistent (> or =5 min) ischemia, or hemodynamic instability, occurred in any of the patients. Ischemia was induced and detected in 73 of the 80 (91%) patients. Conclusion Dobutamine stress echocardiography is feasible in anesthetized patients with severe coronary artery disease. The lack of serious complications and the high sensitivity to detect inducible ischemia in this patient population provide the basis for further evaluation of the safety and diagnostic value of dobutamine stress echocardiography during general anesthesia in larger studies of patients at risk for coronary artery disease undergoing noncardiac surgery.

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