title: Enhanced sensitivity for detection of coronary artery disease by addition of atropine to dipyridamole echocardiography.
abstract: Dipyridamole echocardiography test (DET) has gained acceptance due to its safety, feasibility, diagnostic accuracy and prognostic power. The main limitation of the test is a less than ideal sensitivity in some patient subsets, such as those with limited coronary artery disease. Atropine with dipyridamole might theoretically combine to become a synergistic ischaemic stress test, by increasing myocardial oxygen demand through chronotropic stress and by reducing flow supply through a shortening of the diastolic interval under maximal coronary vasodilation. The aim of this study was to assess the effects of the addition of atropine to DET. Three hundred and twenty-one patients (age = 58 +/- 9 years), referred for testing in the echo lab, were initially studied by DET. Of these, 151 were stopped during or within the 2 min following dipyridamole infusion because of achievement of a predetermined end-point: obvious echocardiographic positivity (n = 137), severe chest pain (n = 3), diagnostic ST segment changes (n = 7) or limited side effects (n = 4). In another three cases, atropine was not given due to a history of glaucoma or severe prostatic hypertrophy. In the remaining 167 patients with a negative DET test, atropine (0.25 mg intravenously, repeated every min up to a maximum of 1 mg, if necessary) was added, starting 3 min after the end of the dipyridamole infusion. The dipyridamole-atropine echo test (DETA) was positive in 32 and negative in 135 patients, and no major side effects occurred in any patient.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Istituto di Fisiologia Clinica, CNR, Pisa, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Picano
authors.forename: A
authors.initials: A
authors.lastname: Pingitore
authors.forename: U
authors.initials: U
authors.lastname: Conti
authors.forename: M
authors.initials: M
authors.lastname: Kozàkovà
authors.forename: A
authors.initials: A
authors.lastname: Boem
authors.forename: E
authors.initials: E
authors.lastname: Cabani
authors.forename: M
authors.initials: M
authors.lastname: Ciuti
authors.forename: A
authors.initials: A
authors.lastname: Distante
authors.forename: A
authors.initials: A
authors.lastname: L'Abbate
mesh_terms: D000328:Adult; D000368:Aged; D001285:Atropine / Q000494:pharmacology; D001794:Blood Pressure / Q000187:drug effects; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004176:Dipyridamole / Q000494:pharmacology; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity
chemical_list: D004176:Dipyridamole; D001285:Atropine