DOBUTAMINE AND IMPROVEMENT OF REGIONAL AND GLOBAL LEFT-VENTRICULAR FUNCTION IN CORONARY-ARTERY DISEASE

The effects of dobutamine infusion on left ventricular (LV) function in patients with coronary artery disease (CAD) have not been completely defined. Some studies have suggested that dobutamine infusion can be used to achieve a significant increase in myocardial oxygen demand in the presence of severe stenosis, revealing physiologically significant ischemia.1-3 This would be particularly desirable as an alternative to exercise stress testing because some patients are unable to achieve target heart rates due to insufficient motivation, poor physical condition or peripheral vascular disease. Studies with contrast ventriculography using postextrasystolic stimulation and epinephrine infusion have suggested that viable, but poorly contracting myocardium, often responds to these stimuli and can thus be differentiated from infarcted, irreversibly injured myocardium.4,5 The pharmacologic profile of dobutamine as a relatively selective β-1 agonist6 suggests that dobutamine also may stimulate viable but "hibernating" myocardium.5 In this report, the effects of dobutamine infusion on global LV ejection fraction and abnormal LV regional wall motion have been assessed in 15 patients with coronary artery disease. The goal of the study was to determine whether dobutamine "stress" would induce a diminished LV ejection fraction and provoke new LV wall motion abnormalities or improve global and/or regional LV dysfunction. © 1990.