Dobutamine effect on ankle-brachial pressure index in patients with peripheral arterial occlusive disease. New noninvasive test for evaluation of peripheral circulation?

BACKGROUND: This study was designed to evaluate the effect of short-term administration of graded dose of dobutamine on the circulation of the lower limbs in the patients with symptomatic peripheral arterial occlusive disease.

METHODS: An ankle-brachial pressure index (ABI) was determined at the time of dobutamine stress echocardiography by measuring systolic pressure over the brachial artery and right dorsalis pedis artery using continuous-wave Doppler instrument. Setting. The study was conducted on all patients who had dobutamine stress echocardiography ordered by their referring physicians and performed in the Echocardiography Laboratory of the Mayo Clinic. Patients. All patients scheduled for dobutamine stress echocardiography were the subject of this study unless they had rigid vessels defined as ABI > 1.5, were on beta-blockers or did not agree to participate in the study. 20 patients, mean age 67 +/- 9 years (9 men and 11 women) without peripheral occlusive arterial disease and resting ABI > or = 1.0 (group A), and 18 patients, mean age 71 +/- 10 years (11 men and 7 women) with the evidence of peripheral occlusive arterial disease and ABI < 1.0 were examined. Measures. ABI was measured just prior to starting the dobutamine infusion, and then at the third minute of each increment in dobutamine dosage.

RESULTS: In control group patients ABI rises at 5-10 micrograms/kg/min of dobutamine infusion and at higher doses (20-50 micrograms/kg/min) drops back to the baseline values. In the patients with peripheral arterial occlusive disease low doses of dobutamine do not increase ABI, but higher doses cause decrease of pressure index from 0.6 to 0.3. There was no incidence of ischemic pain or any other kind of discomfort in the lower extremities.

CONCLUSIONS: Low doses of dobutamine have no decremental effect on peripheral circulation. High doses of dobutamine cause a profound decrease of blood pressure in the lower limbs of patients with peripheral occlusive arterial disease, and the extent of decrease was proportional to the degree of ischemia. Peripheral blood pressure changes registered in the study over dorsalis pedis artery at the time of dobutamine infusion resemble those that occurred at the time of exercise-walking test. ABI measurement at the time of dobutamine echocardiography might be a useful test for the evaluation of peripheral circulation. Further studies are necessary for the assessment of a clinical usefulness of dobutamine-ankle-brachial test.