Dobutamine-atropine stress echocardiography in elderly patients unable to perform an exercise test. Hemodynamic characteristics, safety, and prognostic value.
OBJECTIVE
To establish the hemodynamic effects, safety, and prognostic value of dobutamine-atropine stress echocardiography in patients 70 years of age or older.


METHODS
Observational study at a university hospital.


METHODS
One hundred seventy-nine patients (mean age, 75 years; range, 70 to 90 years) referred for chest pain (n = 73) or preoperative risk assessment for major vascular noncardiac surgery (n = 106).


METHODS
All patients underwent clinical evaluation and dobutamine-atropine stress test.


RESULTS
One hundred seventy-nine stress tests were performed. Test end points were the target heart rate (85% of theoretical maximum heart rate), reached in 165 tests (92%); inadequate echo images, two tests (1%); and side effects, 12 tests (7%). Side effects that caused a premature end of the test were severe chest pain (n = 5 [2.8%]), electrocardiographic changes (n = 1 [0.6%]), hypotension (n = 2 [1.1%]), chills (n = 2 [1.1%]), and cardiac arrhythmias (paroxysmal atrial fibrillation) (n = 2 [1.1%]). New wall motion abnormalities as a marker of myocardial ischemia occurred in 50 tests (28%). No death or myocardial infarction occurred during the test. Perioperative events occurred in 12 patients (four cardiac deaths, three myocardial infarctions, and five episodes of unstable angina). During 16 +/- 6 months (mean +/- SD) of follow-up of 166 patients, 22 cardiac events occurred (eight cardiac deaths, four myocardial infarctions, and 10 episodes of unstable angina pectoris). By multivariate regression analysis, only perioperative cardiac events (odds ratio, 51; 95% confidence interval, 5.8 to 454) and late cardiac events (odds ratio, 5.2; 95% confidence interval, 2.0 to 14) were correlated with new wall motion abnormalities during stress.


CONCLUSIONS
Dobutamine-atropine stress echocardiography is a feasible and safe test for assessing elderly patients with suspected and/or proven coronary artery disease, providing useful prognostic information for perioperative and late cardiac risk with relatively few side effects.
Poldermans
D
D
Department of Vascular Surgery, University Hospital Rotterdam-Dijkzigt, The Netherlands.
Fioretti
P M
PM
Boersma
E
E
Thomson
I R
IR
Cornel
J H
JH
ten Cate
F J
FJ
Arnese
M
M
van Urk
H
H
Roelandt
J R
JR
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001285:Atropine / Q000009:adverse effects; D004280:Dobutamine / Q000009:adverse effects; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008297:Male; D016017:Odds Ratio; D012044:Regression Analysis
D004280:Dobutamine; D001285:Atropine