Dobutamine stress echocardiography (DSE) is widely used, TTC-DSE is extremely rare. Our purpose was to compare TTC-DSE reports with DSE exams, to identify triggers of TTC.

Retrospective study:

– systematic analysis of TTC-DSE observations from 2006 to 2020;

– over a 3-year period (2013-2015), selection (data base) of consecutive DSE patients;

– comparison of the two groups.

An extensive search identified 30 TTC-DSE observations, mean age 64 years (52-74) and a high proportion of women (86.6%), all with TTC criteria: Predominance of female>50 years (93.3%); Depression, or anxiety (26.7%); EKG ST elevation (70%); Normal coronary angiography and depressed angio left ventricular ejection fraction (LVEF)<40% (14/18 pts); Typical segmental LV impairment: apical (77.3%); mid-ventricular (13.6%); reverse (9%); Low troponin peak; Rapid recovery of LVEF (29/30 pts), but one death (acute heart failure). The 2nd group of 578 consecutive DSE patients was characterized by older patients (70 vs. 64), and a smaller proportion of women (44 vs. 64%) all P<0;01). The comparison between TTC-DSE vs. DSE showed a greater proportion of smoker (16 vs. 36.6%), the onset of TTC at a higher mean peak dose Dobutamine (40 vs. 30g/kg/mn), but at a lower Maximum Peak Heart Rate (81% vs. 94%), all P<0.01). In a multivariate analysis, female sex (OR=9.6;95%CI: 3-28), smoking (OR=4.8;95%CI: 2-11) and Dobutamine posology (OR=1.07; 95%CI: 1.02-1.12) were independent predictors of TTC-DSE (all P<0;01). Dobutamine posology>30 gammas/kg/mn was the best cut-off (AUC 0.7±0.04, P<0.01) to predict TTC-DSE.

By comparison with DSE patients, independent factors (female sex, smoker, Dobutamine posology>30 gammas/kg/mn) are predictive of TTC-DSE. Superimposable to the usual TTC, TTC-DSE remains, however, poorly explained.