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      Beat-to-Beat QRS Amplitude Variability during Dobutamine Infusion in Patients with Coronary Artery Disease


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          The aim of this study was to investigate if provoked myocardial ischemia induces increased beat-to-beat QRS amplitude variability in patients with angiographically verified coronary artery disease. 15 patients (median age 62 years, range 46-73 years) and 10 healthy controls (median age 25 years, range 22-42 years) were studied. Dobutamine was infused intravenously at a low and at a high dose. The mean low dose of the drug was 10.0 µg/kg/min for both patients and controls, whereas the mean maximum dose was 31 ± 2 for patients and 38 ± 1 µg/kg/min for controls. The total QRS amplitude beat-to-beat variance from 12 leads as well as individual variance scores in each single lead were evaluated. Before infusion, the total QRS variance did not differ between patients and controls, nor did the individual variance in 9 of the 12 ECG leads. Dobutamine elicited an increase (p < 0.01) in the total QRS variance, with significantly higher (p < 0.001) total variance in patients than in controls. At the high dose of the drug, the patients displayed significantly higher individual variance values in each ECG lead as well. During dobutamine infusion, 7 of 15 patients developed ST depressions ( ≧ 0.1 mV in ≧ 2 leads) in 12-lead ECG readings. Eleven of 15 patients developed chest pain (grade > 3 at the Borg’s CR-10 scale). In conclusion, in patients with ischemic heart disease, dobutamine-provoked stress gives rise to increased QRS amplitude beat-to-beat variability, as a sign of electrical instability of the myocardium.

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          Author and article information

          S. Karger AG
          19 November 2008
          : 87
          : 2
          : 161-168
          Departments of aMedicine and bClinical Physiology, Huddinge University Hospital, Karolinska Institute, Huddinge, Sweden
          177080 Cardiology 1996;87:161–168
          © 1996 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          : 27 December 1994
          : 17 February 1995
          Page count
          Pages: 8
          Noninvasive and Diagnostic Cardiology

          General medicine,Neurology,Cardiovascular Medicine,Internal medicine,Nephrology
          Dobutamine,Ischemic heart disease,QRS variance


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