Pneumatic Lower Extremity Compression During Dobutamine Stress Echocardiography

Dae-Won Sohn, Hyung-Kwan Kim, Jin-Shik Park, Yong-Jin Kim, Joo-Hee Zo, Byung-Hee Oh, Young-Bae Park, Yun-Shik Choi
2008 Circulation Journal  
obutamine stress echocardiography (DSE) is an accepted modality for diagnosis of coronary artery disease. DSE has similar diagnostic accuracy 1-4 to exercise stress echocardiography, provides high-quality images and can be used for patients who are unable to exercise. However, dobutamine has different hemodynamic effects to exercise. During high-dose dobutamine infusion, there is a dose -dependent reduction in systemic vascular resistance, which leads to a reduction in left ventricular (LV)
more » ... entricular (LV) cavity size, 5,6 resulting in diminished LV wall tension and possibly decreasing the sensitivity of the test. Pneumatic compression of the lower part of the body has been used to prevent blackout of pilots subjected to high gravity forces (G-suit), 7,8 and in the treatment of hemorrhagic shock or hypotension (medical antishock trousers: MAST) in the emergency setting. 9,10 Hemodynamic evaluation of pneumatic compression of the lower part of the body has revealed that afterload increases with compression, 11,12 so we hypothesized that by increasing the afterload, pneumatic compression of the lower part of the body during DSE would increase sensitivity of the test or shorten the time to a positive response. For the comfort of the patients, in the present study we limited the pneumatic compression to the lower extremities and evaluated its effect during DSE. Methods Study Subjects Forty patients who underwent DSE for evaluation of chest pain and who were scheduled for coronary angiography (CAG) were enrolled (24 males; mean age 61.3±9.3 years). Before CAG, DSE was repeated with pneumatic lower extremity compression (DSEcomp) a mean 3.2±13.5 days after DSE. Patients with symptoms and physical findings suggestive of peripheral artery disease were excluded. Informed consent was given by all enrolled patients. Pneumatic Lower Extremity Compression Pneumatic trousers without the bladder for compression of the lower abdomen were put on to the patient. At the beginning of the study a specially designed compressor inflated the pneumatic trousers to 100 mmHg of pressure on both lower extremities and inflation was maintained throughout the examination. DSE DSE was performed as previously described. 13 Dobutamine infusion was started at 5 g·kg -1 ·min -1 and increased to 10, 20, 30 and 40 g·kg -1 ·min -1 at 3 min intervals. Intravenous atropine (0.25 mg boluses to a maximum dose of 1 mg) was added if the target heart rate (HR) was not achieved at the peak of dobutamine infusion. Blood pres-Circ J 2008; 72: 251 -255
doi:10.1253/circj.72.251 pmid:18219162 fatcat:bew6smkojfhlpn2tqdh3yiryiq