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\begin{document}

\title{Myocardial injury in stress echocardiography: comparison of dobutamine,
dipyridamole and dynamic stressors - single center study}



\author[1]{Karel Medilek}%
\author[1]{Lenka Zaloudkova}%
\author[2]{Alexander Borg}%
\author[3]{Lucie Brozova}%
\author[1]{Josef Stasek}%
\affil[1]{Fakultni Nemocnice Hradec Kralove}%
\affil[2]{University of Malta}%
\affil[3]{Masarykova univerzita Lekarska fakulta}%


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  \date{May 24, 2024}


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\begin{abstract}
\textbf{Objectives} In stress echocardiography (SE), dipyridamole (DIP)
and dynamic stress (ExSE) are reported as safer than dobutamine stress
(DSE). We investigated whether commonly used stressors cause myocardial
injury, measured by high sensitivity troponin T (hsTnT).
\textbf{Methods} 135 patients (DSE n=46, ExsE n=46, DIP n=43) with
negative SE were studied. Exclusion criteria were known ischemic heart
disease (IHD), baseline wall motion abnormalities, left ventricle
systolic dysfunction/regional wall motion abnormalities,
septum/posterior wall [?]13 mm, diabetes, baseline hsTnT level [?]14 ng/L,
baseline blood pressure [?]160/100 mmHg, peak pulmonary pressure [?]45mmHg,
eGFR \textless{}1mL/s/1.73m2, more than mild to moderate valvular
disease and dobutamine side effects. HsTnT was measured before and 180
minutes after the test. \textbf{Results} All patients had low pre-test
probability of IHD. HsTnT increased in DSE, less so in ExSE, and
unchanged in DIP group {[}9.4 (1.5--58.6), 1.1 (-0.9--15.7), -0.1
(-1.4--2.1) ng/L, p\textless{}0.001{]}. In DSE, hsTnT change was
associated with peak dobutamine dose (r=0.30, p= 0.045), test length
(r=0.43, p=0.003) and atropine use (p\textless{}0001). In ExSE, hsTnT
rise was more likely in females (p=0.012) and elderly (\textgreater{}65
years) (r=0.32, p=0.03), no association was found between atropine use
(p=0.786) or test length and hsTnT rise (r=0.10, p=0.530).
\textbf{Conclusions} DSE is associated with myocardial injury in
patients with negative SE, no injury was observed in DIP and only mild
one in ExSE. Whether myocardial injury is causative of the higher
reported adverse event rates in DSE remains to be determined.%
\end{abstract}%



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