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Pharmacological stress echocardiography - is this a safe exam to perform? Data from a 6-year single centre experience
Session:
Painel 3 - Imagiologia Cardiovascular 5
Speaker:
Ana Marques
Congress:
CPC 2020
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Posters
FP Number:
---
Authors:
Ana I. Marques; João Carvalho; Alexandra Briosa; Sofia Alegria; Ana Rita F. Pereira; João Grade Santos; Daniel Sebaiti; Inês Cruz; Ana Almeida; Isabel João; Paula Fazendas; Luís Lopes; Carlos Cotrim; Helder Pereira
Abstract
<p>Introduction: With increasing age and co-morbidities of patients and widely use of pharmacological stress echocardiography (PSE), its safety and side effects should be known.</p> <p>Objectives: To assess incidence of PSE complications. To evaluate factors associated with higher incidence of complications.</p> <p>Methods: Retrospective single-center study including all consecutive PSE performed during a 6-year period (2011-2016). Major complications were defined as death or conditions requiring hospitalization. Minor complications were defined as symptoms that were not tolerable by the patient, no life-threatening arrythmias and arterial hyper or hypotension. Univariate analysis was performed.</p> <p>Results: Were performed 1484 PSE: 1227 (83%) using dobutamine and 257 (17%) using dipyridamole. The tests were performed in male patients in 56%, with mean age of 69±10 years.</p> <p>The main reason for requesting PSE was to evaluate myocardial ischemia (n=1421, 96%): in 60% in pts without previous diagnose of coronary artery disease (of which in 12% during pre-operative non-cardiac surgery evaluation) and in 39% to evaluate residual ischemia post-coronary revascularization. The test was negative in 81%, positive in 9.5% tests and inconclusive in the remaining tests.</p> <p>Complications occurred in 331 (22.3%) tests. Nine (0.6%) major complications occurred, all requiring hospitalization: 4 chest pain with ST-segment elevation, 2 refractory chest pain, 2 sustained ventricular tachycardia and 1 unstable high rate atrial fibrillation. No death occurred.</p> <p>Minor complications occurred in 322 exams (21.7%). The mostly common minor complications were frequent premature ventricular beats (7.7%), chest pain (4.5%) and arterial hypotension (3.4%).</p> <p>Early stopping of drug infusion with prematurely ended exams occurred in 64 (4.3%) tests, mostly due to arterial hypotension (n=16) and hypertension (n=14).</p> <p>Complications occurred more frequently with dobutamine compared to dipyridamole PSE (25 vs 9%, p<0.001), and in those tests whose result was inconclusive (46%) or positive (40%) (p<0.001).</p> <p>Conclusion: Incidence of major complications was 6 events/1.000 exams. Minor complications occurred in 21.7/100 exams performed. Early stopping of drug infusion with prematurely ended exams occurred in 4.3 per 100 exams performed. Dobutamine stress echocardiography was associated with higher incidence of complications, as well as positive or inconclusive result tests.</p>
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