Normal stroke volume and cardiac output response during dobutamine stress echocardiography in subjects without left ventricular wall motion abnormalities

Dobutamine stress echocardiography has become widely utilized for evaluation of coronary artery disease, but the expected responses of stroke volume and cardiac output to the high doses of dobutamine administered in these studies are not known. To determine these responses, stroke volume and cardiac output were measured with 2-dimensional Doppler echocardiography at each stage of dobutamine stress echocardiography and after administration of atropine in 47 patients without resting or inducible wall motion abnormalities. Heart rate increased significantly at each stage of dobutamine infusion and after atropine. Mean blood pressure decreased at the 5 μg/kg/min dose, then showed little change. Stroke volume increased 27 ± 18% from baseline, with significant increases occurring at both the 5 and 10 μg/kg/min doses (p < 0.00001). With higher doses of dobutamine, stroke volume tended to plateau or decrease. Mean changes in stroke volume were not significant between the doses of 10, 20, and 30 μg/kg/min. The mean change in stroke volume from the 30 to the 40 μg/kg/min dose was a significant decrease of 6.3% (p = 0.004); the decrease from the 40 μg/kg/min dose to atropine approached statistical significance (p = 0.06). Cardiac output increased throughout dobutamine infusion. Stroke volume during dobutamine stress echocardiography is commonly maximum at a dose of 20 μg/kg/min and tends to decline at higher infusion rates. At higher doses, increases in cardiac output are mediated primarily by increases in heart rate.