Target heart rate to determine the normal value of coronary flow reserve during dobutamine stress echocardiography

Cardiovascular Ultrasound

Research

Ezequiel H Forte¹  Maria G Rousse¹  Jorge A Lowenstein¹ 

[1] Investigaciones Médicas, Buenos Aires, Argentina;

关键词: Dobutamine;    Left Anterior Descend;    Coronary Flow Reserve;    Dobutamine Stress Echocardiography;    Dobutamine Infusion;   

DOI  :  10.1186/1476-7120-9-10

 received in 2010-11-30, accepted in 2011-04-04,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundThe determination of coronary flow reserve (CFR) is an essential concept at the moment of decision-making in ischemic heart disease. There are several direct and indirect tests to evaluate this parameter. In this sense, dobutamine stress echocardiography is one of the pharmacological method most commonly used worldwide. It has been previously demonstrated that CFR can be determined by this technique. Despite our wide experience with dobutamine stress echocardiography, we ignored the necessary heart rate to consider sufficient the test for the analysis of CFR. For this reason, our main goal was to determine the velocity of coronary flow in each stage of dobutamine stress echocardiography and the heart rate value necessary to double the baseline values of coronary flow velocity in the territory of the left anterior descending (LAD) coronary artery.MethodsA total of 33 consecutive patients were analyzed. The patients included had low risk for coronary artery disease. All the participants underwent dobutamine stress echocardiography and coronary artery flow velocity was evaluated in the distal segment of LAD coronary artery using transthoracic color-Doppler echocardiography.ResultsThe feasibility of determining CFR in the territory of the LAD during dobutamine stress echocardiography was high: 31/33 patients (94%). Mean CFR was 2.67 at de end of dobutamine test.There was an excellent concordance between delta HR (difference between baseline HR and maximum HR) and the increase in the CFR (correlation coefficient 0.84). In this sense, we found that when HR increased by 50 beats, CFR was ≥ 2 (CI 93-99.2%). In addition, 96.4% of patients reached a CFR ≥ 2 (IC 91.1 - 99%) at 75% of their predicted maximum heart rate.ConclusionsWe found that the feasibility of dobutamine stress echocardiography to determine CFR in the territory of the LAD coronary artery was high. In this study, it was necessary to achieve a difference of 50 bpm from baseline HR or at least 75% of the maximum predicted heart rate to consider sufficient the test for the analysis of CFR.

【 授权许可】

CC BY   
© Forte et al; licensee BioMed Central Ltd. 2011