Atropine increases the accuracy of dobutamine stress echocardiography in patients taking beta-blockers.
Dobutamine-atropine stress echocardiography is used for the non-invasive diagnosis of coronary artery disease, but stress test results may be influenced by beta-blockers. The aim of this study was to assess if the addition of atropine can compensate for the presence of beta-blockers in dobutamine stress echocardiography. Twenty-six patients referred for evaluation of chest pain were studied twice, on and off metoprolol 100 mg b.i.d. (in random order sequence) with a wash-out period of at least 48 h. Dobutamine stress echocardiography was performed using up to 40 micrograms.kg-1.min-1, followed, if necessary, by the addition of atropine to achieve 85% of the age-predicted maximal heart rate, unless symptoms or markers of ischaemia appeared. Atropine was given to patients on beta-blockers more often [(22/26) vs (6/26)] than to those off beta-blockers (P < 0.001). Heart rate at every stage of the test was lower on beta-blockers. Chest pain occurred in patients on beta-blockers significantly less than in those off beta-blockers (8% vs 46%), and the addition of atropine made no significant difference (31% vs 46%). During dobutamine stress, new wall motion abnormalities occurred in three patients on beta-blockers (12%); this number increased to 15 after the addition of atropine (57%). New or worsened wall motion abnormalities occurred in 12 patients (46%) off beta-blockers with dobutamine alone and in 14 patients after adding atropine (53%).(ABSTRACT TRUNCATED AT 250 WORDS)
Fioretti
P M
PM
Thoraxcenter, University Hospital Rotterdam-Dijkzigt, The Netherlands.
Poldermans
D
D
Salustri
A
A
Forster
T
T
Bellotti
P
P
Boersma
E
E
McNeill
A J
AJ
el-Said
E S
ES
Roelandt
J R
JR
D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000503:physiopathology; D001285:Atropine / Q000494:pharmacology*; D004280:Dobutamine / Q000037:antagonists & inhibitors / Q000494:pharmacology*; D004357:Drug Synergism; D004452:Echocardiography / Q000187:drug effects / Q000379:methods*; D004562:Electrocardiography / Q000187:drug effects; D005080:Exercise Test; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000494:pharmacology / Q000627:therapeutic use; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000517:prevention & control; D011446:Prospective Studies
D004280:Dobutamine; D001285:Atropine; D008790:Metoprolol