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European Heart Journal 1992 13(9):1245-1250;
Copyright © 1992 by the European Society of Cardiology.
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© 1992 The European Society of Cardiology

Comparison of diastolic blood pressure changes with dobutamine and exercise test

I. COMA-CANELLA and F. ORTUÑO

Coronary Care Unit, Coronary Heart Disease Section, La Paz Hospital Madrid, Spain

Received 21 May 1991; revised 27 September 1991; .

Correspondence: I. Coma-Canella, Unidad Coronaria, Hospital la Paz, Paseo de la Castellana 261 28046-Madrid, Spain

Abstract

A total of 80 patienis (44 with stable angina and 36 during coronary angioplasty follow-up) underwent both exercise and dobutaminestress testing within one week. Dobutamine was infusedin doses of 5µg . kg–1. min–1, up to 70 every 5 min with blood pressure and electrocardiographic control. Treadmill exercise testing was performed with a maximal, symptom-limited Bruce protocol. Both systolic blood pressure and heart rate increased significantly with dobutamine and exercise, but the increase was higher with exercise (P = 0·00001). Mean blood pressure increased only with exercise, while diastolic blood pressure increased with exercise and decreased with dobutamine (P = 0·00001). A test was positive when either typicalangina or an ST segment shift ≥1 mm 80 ms after the Jpoint waspresent. There were 28 positive tests with exercise and38 with dobutamine, 22 ofthem coinciding. In 36patients both tests were negative. The concordance between both tests was 73%. When each test was related to coronary angiography, dobutamine showedgreater sensitivity and efficacy than exercise. Conclusions: a dobutamine stress test induces a positive response in more patients than does an exercise stress test, although the increase in systolic blood pressure and heart rate is greater with exercise. The decrease in diastolic blood pressure with dobutamine probablv plays a role in the positive response.

Key Words: Dobutamine • exercise test • blood pressure • diastole


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