Target heart rate to determine the normal value of coronary flow reserve during dobutamine stress echocardiographyReport as inadecuate




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Cardiovascular Ultrasound

, 9:10

First Online: 04 April 2011Received: 30 November 2010Accepted: 04 April 2011

Abstract

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.

Abbreviations and acronymsCFRCoronary Flow Reserve

HRHeart Rate

LADLeft Anterior Descending

MHzMegahertz

MAPMean Arterial Pressure

O2Oxygen.

Electronic supplementary materialThe online version of this article doi:10.1186-1476-7120-9-10 contains supplementary material, which is available to authorized users.

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Author: Ezequiel H Forte - Maria G Rousse - Jorge A Lowenstein

Source: https://link.springer.com/article/10.1186/1476-7120-9-10







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