Myocardial injury in stress echocardiography: Comparison of dobutamine, dipyridamole and dynamic stressors–single center study. Issue 9 (11th August 2022)

• Record Type: Journal Article
• Authors: Medilek, Karel; Zaloudkova, Lenka; Borg, Alexander; Brozova, Lucie; Stasek, Josef
• Is Part Of: Echocardiography. Volume 39:Issue 9(2022)
• Page Start: 1171
• Page End: 1179
• Publication Date: 2022-08-11
• Subjects: negative stress echocardiography -- myocardial injury -- hsTnT; Echocardiography -- Periodicals; Echocardiography -- Periodicals; 616.1207543
• DOI: 10.1111/echo.15411
• Languages: English
• ISSNs: 0742-2822

Abstract

Abstract: 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/1.73m 2, 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.