ORIGINAL ARTICLES   

International Angiology 1998 September;17(3):201-7

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

Dobutamine effect on ankle-brachial pressure index in patients with peripheral arterial occlusive disease. New noninvasive test for evaluation of peripheral circulation?

Wysokinski E. E., Spittell P. C., Pellikka P. A., Miller W. L., Seward J. B.

From the Division of Cardiovascular Disease and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905

Background. This study was ­designed to eval­u­ate the ­effect of short-term admin­is­tra­tion of grad­ed dose of dobu­ta­mine on the cir­cu­la­tion of the lower limbs in the ­patients with symp­to­mat­ic periph­er­al arte­ri­al occlu­sive dis­ease.
Methods. An ankle-bra­chi­al pres­sure index (ABI) was deter­mined at the time of dobu­ta­mine ­stress ech­o­car­di­og­ra­phy by meas­ur­ing sys­tol­ic pres­sure over the bra­chi­al ­artery and right dor­sal­is pedis ­artery using con­tin­uous-wave Doppler instru­ment. Setting. The study was con­duct­ed on all ­patients who had dobu­ta­mine ­stress ech­o­car­di­og­ra­phy ­ordered by their refer­ring phy­si­cians and per­formed in the Echocardiography Laboratory of the Mayo Clinic. Patients. All ­patients sched­uled for dobu­ta­mine ­stress ech­o­car­di­og­ra­phy were the sub­ject of this study ­unless they had rigid ves­sels ­defined as ABI > 1.5, were on β-blok­ers or did not agree to par­tic­i­pate in the study. 20 ­patients, mean age 67±9 years (9 men and 11 women) with­out periph­er­al occlu­sive arte­ri­al dis­ease and rest­ing ABI ≥1.0 (group A), and 18 ­patients, mean age 71±10 years (11 men and 7 women) with the evi­dence of periph­er­al occlu­sive arte­ri­al dis­ease and ABI <1.0 were exam­ined. Measures. ABI was meas­ured just prior to start­ing the dobu­ta­mine infu­sion, and then at the third min­ute of each incre­ment in dobu­ta­mine dos­age.
Results. In con­trol group ­patients ABI rises at 5-10 μg/kg/min of dobu­ta­mine infu­sion and at high­er doses (20-50 μg/kg/min) drops back to the base­line val­ues. In the ­patients with periph­er­al arte­ri­al occlu­sive dis­ease low doses of dobu­ta­mine do not ­increase ABI, but high­er doses cause ­decrease of pres­sure index from 0.6 to 0.3. There was no inci­dence of ischem­ic pain or any other kind of dis­com­fort in the lower extrem­ities.
Conclusions. Low doses of dobu­ta­mine have no decre­men­tal ­effect on periph­er­al cir­cu­la­tion. High doses of dobu­ta­mine cause a pro­found ­decrease of blood pres­sure in the lower limbs of ­patients with periph­er­al occlu­sive arte­ri­al dis­ease, and the ­extent of ­decrease was pro­por­tion­al to the ­degree of ische­mia. Peripheral blood pres­sure chang­es reg­is­tered in the study over dor­sal­is pedis ­artery at the time of dobu­ta­mine infu­sion resem­ble those that ­occurred at the time of exer­cise-walk­ing test. ABI meas­ure­ment at the time of dobu­ta­mine ech­o­car­di­og­ra­phy might be a use­ful test for the eval­u­a­tion of periph­er­al cir­cu­la­tion. Further stud­ies are nec­es­sary for the assess­ment of a clin­i­cal use­ful­ness of dobu­ta­mine-ankle-bra­chi­al test.