Anginal Threshold Between Stress Tests: Exercise Versus Dobutamine Stress Echocardiography

Purpose: Dobutamine echocardiography (DOB) can be substituted to exercise testing when necessary for clinical reasons. Current literature suggests DOB is maximal when 85% of maximal predicted heart rate (%PHR) is achieved (similar to EX), but there is little evidence to determine whether this target has the same clinical significance as during EX. We therefore performed this study to compare the ischemic threshold between EX and DOB. Methods: Twenty men with stable angina underwent in a random order DOB and EX echocardiograms after being weaned off their cardiac medications. Electrocardiography, heart rate (HR), and systolic blood pressure were recorded every minute. Ischemic threshold was defined as the precise time at which clinical angina occurred. Results: Anginal threshold appeared consistently at a higher level for DOB than EX as evidenced by the higher rate-pressure product (RPP) values (22,492 +/- 4,300 vs 20,371 +/- 5,367 bpm x mm Hg, DOB vs EX, respectively, P = 0.02), HR (126 +/- 23 vs 119 +/- 15 bpm, P = 0.01), and %PHR (79 +/- 15% vs 74 +/- 10%, P < 0.01). Thirty-two percent of the subjects presented an ischemic HR above 85% of PHR and 60% had a higher ischemic HR during DOB versus EX. Conclusions: This study shows that estimation of anginal threshold during DOB is feasible and is slightly higher (similar to10%) than during EX. Extrapolation of a cut off target heart rate from an exercise modality to a pharmaceutical one may not be valid.