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Myocardial injury in stress echocardiography: comparison of dobutamine, dipyridamole and dynamic stressors - single center study
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  • Karel Medilek,
  • Lenka Zaloudkova,
  • Alexander Borg,
  • Lucie Brozova,
  • Josef Stasek
Karel Medilek
Fakultni Nemocnice Hradec Kralove

Corresponding Author:karelmedilek@hotmail.com

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Lenka Zaloudkova
Fakultni Nemocnice Hradec Kralove
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Alexander Borg
University of Malta
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Lucie Brozova
Masarykova univerzita Lekarska fakulta
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Josef Stasek
Fakultni Nemocnice Hradec Kralove
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Objectives In stress echocardiography (SE), dipyridamole (DIP) and dynamic stress (ExSE) are reported as safer than dobutamine stress (DSE). We investigated whether commonly used stressors cause myocardial injury, measured by high sensitivity troponin T (hsTnT). Methods 135 patients (DSE n=46, ExsE n=46, DIP n=43) with negative SE were studied. Exclusion criteria were known ischemic heart disease (IHD), baseline wall motion abnormalities, left ventricle systolic dysfunction/regional wall motion abnormalities, septum/posterior wall ≥13 mm, diabetes, baseline hsTnT level ≥14 ng/L, baseline blood pressure ≥160/100 mmHg, peak pulmonary pressure ≥45mmHg, eGFR <1mL/s/1.73m2, more than mild to moderate valvular disease and dobutamine side effects. HsTnT was measured before and 180 minutes after the test. Results All patients had low pre-test probability of IHD. HsTnT increased in DSE, less so in ExSE, and unchanged in DIP group [9.4 (1.5–58.6), 1.1 (-0.9–15.7), -0.1 (-1.4–2.1) ng/L, p<0.001]. In DSE, hsTnT change was associated with peak dobutamine dose (r=0.30, p= 0.045), test length (r=0.43, p=0.003) and atropine use (p<0001). In ExSE, hsTnT rise was more likely in females (p=0.012) and elderly (>65 years) (r=0.32, p=0.03), no association was found between atropine use (p=0.786) or test length and hsTnT rise (r=0.10, p=0.530). Conclusions DSE is associated with myocardial injury in patients with negative SE, no injury was observed in DIP and only mild one in ExSE. Whether myocardial injury is causative of the higher reported adverse event rates in DSE remains to be determined.
28 Feb 2022Submitted to Echocardiography
28 Feb 2022Submission Checks Completed
28 Feb 2022Assigned to Editor
07 Mar 2022Reviewer(s) Assigned
19 Apr 2022Review(s) Completed, Editorial Evaluation Pending
19 Apr 2022Editorial Decision: Revise Minor
16 May 20221st Revision Received
19 May 2022Submission Checks Completed
19 May 2022Assigned to Editor
19 May 2022Reviewer(s) Assigned
27 May 2022Review(s) Completed, Editorial Evaluation Pending
07 Jun 2022Editorial Decision: Accept
Sep 2022Published in Echocardiography volume 39 issue 9 on pages 1171-1179. 10.1111/echo.15411