title: Dobutamine-atropine stress echocardiography in elderly patients unable to perform an exercise test. Hemodynamic characteristics, safety, and prognostic value.
abstract: 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.
authors.affiliation: Department of Vascular Surgery, University Hospital Rotterdam-Dijkzigt, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: Poldermans
authors.forename: P M
authors.initials: PM
authors.lastname: Fioretti
authors.forename: E
authors.initials: E
authors.lastname: Boersma
authors.forename: I R
authors.initials: IR
authors.lastname: Thomson
authors.forename: J H
authors.initials: JH
authors.lastname: Cornel
authors.forename: F J
authors.initials: FJ
authors.lastname: ten Cate
authors.forename: M
authors.initials: M
authors.lastname: Arnese
authors.forename: H
authors.initials: H
authors.lastname: van Urk
authors.forename: J R
authors.initials: JR
authors.lastname: Roelandt
mesh_terms: 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
chemical_list: D004280:Dobutamine; D001285:Atropine