Background: Chest pain occurs frequently during dobutamine stress testing and is commonly attributed to ischemia. However, the pathophysiologic significance of dobutamine-induced chest pain is uncertain. The purpose of this study is to explore the correlation between dobutamine-induced chest pain and evidence of ischemia on myocardial perfusion imaging (MPI).
Methods and results: This study included 1608 patients who underwent dobutamine stress MPI at the Mid America Heart Institute (Kansas City, Mo) and were analyzed retrospectively. Patients were divided into those with chest pain during dobutamine infusion versus those without it. Multivariate and chi(2) analyses were conducted to explore the relationship between chest pain and ischemic changes on MPI. Of 1608 patients, 208 (13%) had chest pain with dobutamine whereas 1400 (87%) did not. MPI ischemia was seen in 47% of patients with chest pain and 43% without chest pain (P = .28). Chest pain was not any more predictive of ischemia when analyzed separately by gender (P = .31). Multivariate analysis did not identify chest pain as a predictor of ischemia (P = .19). Significant predictors of scintigraphic ischemic changes were age (P = .001), gender (P < .0001), smoking (P = .0149), and known coronary artery disease (P < .0001).
Conclusion: This large retrospective study suggests that chest pain during dobutamine stress testing is not a predictor of ischemia when analyzed against reversible perfusion defects on SPECT MPI.