[Stress echocardiography with dobutamine: the importance of adding atropine in inconclusive tests].
OBJECTIVE
To study the feasibility of adding atropine after dobutamine infusion in patients with known or suspected coronary artery disease not achieving 85% of predicted maximal heart rate.


METHODS
We studied with dobutamine stress echocardiography 219 patients (174 men e 45 women; mean age +/- SD: 58 +/- 11 years), 126 patients with a previous myocardial infarction and 93 with angor. One hundred and thirty three (61%) also performed coronariography.


METHODS
Dobutamine stress echocardiography protocol consisted of a step-wise infusion of dobutamine from 5 micrograms/kg/min to a maximal dose of 40 micrograms/kg/min or until a new or a worsening wall motion abnormality, 85% of predicted maximal heart rate or any indication for interruption. In patients not achieving any of these end points, intravenous atropine was administered up to 1 mg. Patients were divided in two groups: Group A: infusion of dobutamine alone and Group B: dobutamine plus atropine.


RESULTS
With this protocol the test was interrupted in 41 patients (19%) because of adverse effects that were mild and short lived and resolved with discontinuation of the test. After dobutamine infusion 46% of the tests were nonconclusive, the majority were on beta blocker therapy. After atropine administration there was a significant reduction of the nonconclusive studies to 20% (p < 0.001). In patients with a normal rest echocardiogram the sensitivity and specificity of the test to diagnose significant coronary artery disease was respectively 89% e 100% after atropine. The capacity of the test to detect multivessel disease was also increased after atropine, allowing to reach a sensitivity of 85% and a specificity of 90%.


CONCLUSIONS
Dobutamine stress echocardiogram supplemented with atropine is a safe and accurate method to diagnose significant coronary artery disease and to detect multivessel disease in patients with a previous myocardial infarction with rest wall motion abnormalities.
Fiuza
M
M
UCIM/Medicina IV-A, Hospital de Santa Maria/FML e LA3-CCUL, Lisboa.
Pereirinha
A
A
Pedro
P
P
Dias
E
E
Carvalho
M
M
Dionísio
I
I
da Costa
B
B
de Pádua
F
F
Lopes
M G
MG
D000368:Aged; D001285:Atropine; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000000981:diagnostic imaging; D004280:Dobutamine; D004452:Echocardiography / Q000379:methods* / Q000706:statistics & numerical data; D005080:Exercise Test / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity
D004280:Dobutamine; D001285:Atropine
Ecocardiografia de sobrecarga com dobutamina: a importância de adicionar atropina nas provas inconclusivas.