Myocardial injury in stress echocardiography: Comparison of dobutamine, dipyridamole and dynamic stressors–single center study
Corresponding Author
Karel Medilek FRCP
Department of Cardio-Angiology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
Faculty of Medicine Hradec Kralove, Charles University Prague, Hradec Kralove, Czech Republic
Correspondence
Karel Medilek, Department of Cardio-Angiology, University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove 500 05, Czech Republic.
Email: [email protected]
Search for more papers by this authorLenka Zaloudkova ING
Department of Clinical Biochemistry, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
Search for more papers by this authorAlexander Borg MD, MRCP
Department of Cardiology, Mater Dei Hospital, Triq Dun Karm, L-Imsida MSD, Malta
University of Malta, Msida MSD, Malta
Search for more papers by this authorLucie Brozova RNDR
Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
Search for more papers by this authorJosef Stasek PhD
Department of Cardio-Angiology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
Faculty of Medicine Hradec Kralove, Charles University Prague, Hradec Kralove, Czech Republic
Search for more papers by this authorCorresponding Author
Karel Medilek FRCP
Department of Cardio-Angiology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
Faculty of Medicine Hradec Kralove, Charles University Prague, Hradec Kralove, Czech Republic
Correspondence
Karel Medilek, Department of Cardio-Angiology, University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove 500 05, Czech Republic.
Email: [email protected]
Search for more papers by this authorLenka Zaloudkova ING
Department of Clinical Biochemistry, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
Search for more papers by this authorAlexander Borg MD, MRCP
Department of Cardiology, Mater Dei Hospital, Triq Dun Karm, L-Imsida MSD, Malta
University of Malta, Msida MSD, Malta
Search for more papers by this authorLucie Brozova RNDR
Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
Search for more papers by this authorJosef Stasek PhD
Department of Cardio-Angiology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
Faculty of Medicine Hradec Kralove, Charles University Prague, Hradec Kralove, Czech Republic
Search for more papers by this authorAbstract
Objectives
In stress echocardiography (SE), dipyridamole (DIP) and dynamic stress (ExSE) are reported as being safer than dobutamine stress echocardiography (DSE). We investigated whether these commonly used stressors cause myocardial injury, measured by high sensitivity troponin T (hsTnT).
Methods
One hundred and thirty five patients (DSE n = 46, ExsE n = 46, DIP n = 43) with negative result of SE were studied. The exclusion criteria were known ischaemic heart disease (IHD), baseline wall motion abnormalities, left ventricle systolic dysfunction/regional wall motion abnormalities, septum/posterior wall ≥13 mm, diabetes/pre-diabetes, baseline hsTnT level ≥14 ng/L, baseline blood pressure ≥160/100 mmHg, peak pulmonary pressure ≥45mmHg, eGFR <1ml/s/1.73m2, more than mild to moderate valvular disease and dobutamine side effects. HsTnT was measured before and 180 minutes after the test.
Results
All patients had low pre-test probabilities of having obstructive IHD. HsTnT increased in DSE, less so in ExSE, and was unchanged in the DIP group (∆hsTnT 9.4 [1.5–58.6], 1.1 [-0.9–15.7], -0.1 [-1.4–2.1] ng/L, respectively, p<0.001). In DSE, the ∆hsTnT was associated with peak dobutamine dose (r = 0.30, p = 0.045), test length (r = 0.43, p = 0.003) and atropine use (p<0.001). In ExSE, the hsTnT increase was more likely in females (p = 0.012) and the elderly (>65 years) (r = 0.32, p = 0.03); no association was found between atropine use (p = 0.786) or test length and ∆hsTnT (r = 0.10, p = 0.530).
Conclusions
DSE is associated with myocardial injury in patients with negative SE, no injury was observed in DIP and only mild case in ExSE. Whether myocardial injury is causative of the higher reported adverse event rates in DSE remains to be determined.
CONFLICT OF INTEREST
The authors declare that there are no conflicts of interest related to this study.
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