Individuals with high BMI and low SBP more likely to have stress-induced CBF decrease during dobutamine stress test

Dobutamine is a medication commonly used in the treatment of cardiogenic shock and severe heart failure. It is known to also be used in certain types of cardiac stress tests. Cerebral microcirculation plays an important role in ensuring adequate oxygen transport. It is unclear whether dobutamine, promotes increased myocardial contractility, affects brain microcirculatory behavior.

Dobutamine-induced stress decreased Cerebral Blood Flow (CBF) in the frontal lobe anterior circulation significantly. Individuals with a high BMI and low systolic blood pressure (SBP) during the dobutamine stress test are more likely to have a stress-induced CBF decrease finds a study in BMC Medicine.

Researchers aimed to find the effects of dobutamine on cerebral hemodynamics. Forty-eight healthy volunteers without cardiovascular or cerebrovascular disease underwent MRI to obtain cerebral blood flow (CBF) maps using 3D pseudocontinuous arterial spin labeling before and during the dobutamine stress test. Additionally, cerebrovascular morphology was obtained based on 3D-time-off-light (3D-TOF) magnetic resonance angiography (MRA). Electrocardiogram, heart rate (HR), respiration rate (RR), blood pressure, and blood oxygen were simultaneously recorded before and during dobutamine injection and during recovery (not during MRI). The anatomic features of the circle of Willis and the basilar artery (BA) diameter were assessed on MRA images by two radiologists with extensive neuroimaging experience. Binary logistic regression was used to test for the independent determinants of CBF changes.

The study found that

• Heart Rate, RR, systolic (SBP), and diastolic blood pressure (DBP) significantly increased after dobutamine infusion. Blood oxygen levels remained similar.

• Compared to the CBF in the resting state, the CBF values exhibited significantly lower CBF levels in both grey matter and white matter.

• Furthermore, compared with the CBF in the resting state, that in the stress state was decreased in the anterior circulation, mainly in the frontal lobe (voxel level P < 0.001, pixel level P < 0.05).

• Logistic regression showed that body mass index (BMI; odds ratio [OR] 5.80, 95% confidence interval [CI] 1.60–21.01, P = 0.008], resting SBP (OR 0.64, 95% CI 0.45–0.92, P = 0.014), and BA diameter (OR 11.04, 95% CI 1.05–116.53, P = 0.046) were significantly associated with frontal lobe CBF changes.

In conclusion, Dobutamine-induced stress significantly decreased CBF in the frontal lobe anterior circulation. Individuals with a high BMI and low SBP during the dobutamine stress test are more likely to have a stress-induced CBF decrease. Thus, attention should be paid to blood pressure, BMI, and cerebrovascular morphology of patients undergoing dobutamine stress echocardiography or those receiving intensive care or anesthesia.7

Reference: Zhang, T., Niu, H., Liu, Y. et al. Dobutamine-induced alternations in cerebral blood flow of healthy adults: a 3D pseudocontinuous arterial spin labeling study. BMC Med 21, 238 (2023). https://doi.org/10.1186/s12916-023-02928-1