Dobutamine stress echocardiography (DSE) is a useful and safe provocation test for
myocardial ischemia. Until now, the test has been focused only on the organic lesion in the coronary artery, and positive DSE has indicated the presence of significant fixed
coronary artery stenosis. The aim of the present study is to examine whether
myocardial ischemia due to coronary
spasm is induced by
dobutamine. We performed DSE on 51 patients with coronary
spastic angina but without significant fixed
coronary artery stenosis. All patients had anginal attacks at rest with ST elevation on the electrocardiogram (variant angina). Coronary
spasm was induced by intracoronary injection of
acetylcholine, and no fixed
coronary artery stenosis was documented on angiograms in all patients. DSE was performed with intravenous
dobutamine infusion with an incremental doses of 5, 10, 20, 30, and 40 microg/kg/min every 5 minutes. Of the 51 patients, 7 patients showed asynergy with ST elevation. All 7 patients (13.7%) had
chest pain during asynergy, and both
chest pain and electrocardiographic changes were preceded by asynergy. These findings indicate that
dobutamine can provoke coronary
spasm in some patients with coronary
spastic angina. When DSE is performed to evaluate
coronary artery disease, not only fixed
coronary stenosis, but also coronary
spasm should be considered as a genesis of asynergy.