Safety and tolerability of dobutamine-atropine stress echocardiography: a prospective, multicentre study (original) (raw)
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The American Journal of Cardiology, 1994
The purpose of this study was to establish the safety of high-dose dobutamine-atropine stress echocardiography in patients with suspected or proven coronary artery disease. Six hundred fifty consecutive examinations were completed. Mean age of patients was 61 years; 300 had a previous myocardial infarction. Heart rate increased from 73 to 129 beats/min during stress testing, blood pressure did not change significantly (from 140/81 to 150/80 mm Hg). Atropine was added to dobutamine in 239 patients when no ischemia was induced with dobutamine alone and the peak heart rate was < 85% of the theoretical maximal heart rate. Atropine was more frequently administered to patients taking beta blockers (77 vs 27%, p < 0.001). New wall motion abnormalities developed in 243 patients (37%). Significant or symptomatic cardiac tachyarrhythmias, or both, developed during 24 examinations: 1 patient developed ventricular fibrillation, 3 patients developed sustained ventricular tachycardia, 12 patients experienced nonsustained ventricular tachycardia (< 10 beats) and 8 patients had paroxysmal atrial fibrillation. Cardiac arrhythmias were more frequent in patients with a history of ventricular arrhythmias (ventricular tachycardia and fibrillation) (odds ratio 9.9, 2.0 to 45) or left ventricular dysfunction at rest (wall motion score > 1.12) (odds ratio 2.9, 1.1-7.6), but not associated with atropine addition. No death or myocardial infarction occurred. The full dose was not given to 13 patients despite absence of signs or markers of ischemia for limiting side effect, yielding an overall feasibility of the stress test of 98%.(ABSTRACT TRUNCATED AT 250 WORDS)
Feasibility, safety and tolerability of accelerated dobutamine stress echocardiography
Cardiovascular Ultrasound, 2007
A continuous infusion of a single high dose of dobutamine has been, recently, suggested as a simple and effective protocol of stress echocardiography. The present study assesses the feasibility, safety, and tolerability of an accelerated dobutamine stress protocol performed in patients with suspected or known coronary artery disease. Two hundred sixty five consecutive patients underwent accelerated dobutamine stress echocardiography: the dobutamine was administered at a constant dose of 50 μg/kg/min for up to 10 minutes. The mean weight-adjusted cumulative dose of dobutamine used was 330 ± 105.24 μg/kg. Total duration of dobutamine infusion was 6.6 ± 2.1 min. Heart rate rose from 69.9 ± 12.1 to 123.1 ± 22.1 beats/min at peak with a concomitant change in systolic blood pressure (127.6 ± 18.1 vs. 167.6 ± 45.0 mmHg). Dobutamine administration produced a rapid increase in heart rate (9.4 ± 5.9 beats/min 2 ). The side effects were similar to those described with the standard protocol; the most common were frequent premature ventricular complexes (21.5%), frequent premature atrial complexes (1.5%) and non sustained ventricular tachycardia (1.5%); among non cardiac symptoms the most frequent were nausea (3.4%), headache (1.1%) and symptomatic hypotension (1.1%). No major side effects were observed during the test. Our data demonstrate that a continous infusion of a single high dose of dobutamine is a safe and well tolerated method of performing stress echocardiography in patients with suspected or known coronary artery disease. This new protocol requires the administration of lower cumulative dobutamine dose than standard protocol and results in a significant reduction in test time.
Echocardiography
The addition of atropine during dobutamine stress echocardiography (DSE) is increasingly used for detecting coronary artery disease (CAD), but its safety and whether it has added diagnostic accuracy have not been well defined. The aim of this study was to retrospectively compare the complication rate and diagnostic accuracy of three different protocols in the same laboratory. DSE was performed in 1090 patients over a 5-year period. The protocol had included (1) 5' stages up to 30 pglkglmin of dobutamine in the first 184 patients, (2) 3' stages up to 40 pg/kg/min in the next 274 patients, and (3) 3' stages up to 40 pglkglmin with atropine, when required in the last 632 patients. A large number ofpatients (n = 938) underwent coronary angiography within 2 weeks, and 524patients had a significant coronary stenosis (> 50%). I n the whole group of 1090 patients, serious complications developed in 5 patients (one acute myocardial infarction, one sustained ventricular tachycardia, and three prolonged ischemia). Although the incidence was low, there were no detectable differences between protocols. Hypotension, which was defined as a L 20 mmHg decrease in systolic blood pressure from the baseline, was observed in 68 patients. Premature ventricular contraction was the most common arrhythmia. The complication rate was similar among three protocols. The diagnostic accuracy for detecting CAD was nearly the same among three protocols (30 ,ug, 86%; 40 pg, 84%; and 40 pg with atropine, 84%), but the prevalence of CAD was higher with the 30-pgprotocol (65%) than the 40-pg protocol (55%) or 40-pg-with-atropine protocol (53%, P < 0.01). I n 469patients without a previous myocardial infarction, the prevalence of CAD was the same (38-42%). Sensitivity increased P < 0.001) or 40-pg protocol (16%, P < 0.001).
American Journal of Cardiology, 2004
Although dobutamine–atropine stress echocardiography (DASE) is an established method for evaluating patients who have coronary artery disease (CAD), it can increase test duration and a patient's exposure to large doses of dobutamine. New protocols, including the early injection of atropine during dobutamine stress echocardiography (EA-DSE), have been proposed to decrease test duration. This study compared the safety, efficacy, and accuracy of EA-DSE with those of DASE. We retrospectively evaluated 3,163 patients who underwent DASE and 1,664 patients who underwent EA-DSE over a period of 12 years. In EA-DSE, atropine at a dose ≤2 mg was started with 20 μg/kg/min of dobutamine if heart rate was <100 beats/min. Diagnostic accuracy for detecting CAD (>50% stenosis) was assessed in patients who underwent quantitative angiography ≤3 months of stress testing. The dobutamine dose used in EA-DSE was smaller than that used in DASE (31 ± 6 vs 36 ± 6 μg/kg/min, p <0.0001), although the atropine dose was larger (0.8 ± 0.5 vs 0.5 ± 0.25 mg, p <0.0001). EA-DSE resulted in a significantly shorter duration of dobutamine infusion (12.4 ± 2.0 vs 14.6 ± 2.5 minutes, p <0.0001), more diagnostic studies (88% vs 81%, p <0.0001), and a lower incidence of minor adverse effects than did DASE. The rate of major adverse effects was similar in the 2 protocols. Sensitivities, specificities, positive predictive values, negative predictive values, and accuracies for detecting CAD were 84%, 90%, 93%, 76%, and 86% for EA-DSE and 86%, 78%, 84%, 79%, and 82% for DASE, respectively (p = NS). Therefore, EA-DSE is a safe and effective alternative to DASE and had a similar accuracy for the detection of CAD.
International Journal of Cardiology, 2008
We report a case of acute myocardial infarction during a dobutamine stress echo (DSE) study in a middle age man. Our patient experienced a severe crushing retrosternal pain at peak DSE study, at the time the ECG recorded an episode of non-sustained ventricular tachycardia followed by a persistent significant ST segment elevation in V2-V6 leads. Symptoms and ECG findings remained despite the use of intravenous (IV) nitrates and therefore thrombolysis was given. A subsequent coronary angiogram revealed only mild atheromatous changes but no stenosis.