Safety and feasibility of dobutamine-atropine stress echocardiography in patients with ischemic left ventricular dysfunction.
The aim of this study was to analyze whether left ventricular dysfunction affects the safety and feasibility of high-dose dobutamine-atropine stress echocardiography. We examined the results of the test in 318 consecutive patients who were referred for high-dose dobutamine-atropine stress echocardiography and also underwent diagnostic cardiac catheterization. Forty-four patients had a left ventricular ejection fraction of 25% or less (mean, 21%; range, 15% to 25%). In the entire group of 318 patients, no serious complications (death, myocardial infarction, or ventricular fibrillation) occurred. The overall feasibility of completing the test was excellent (97%). A trial fibrillation occurred in four patients, nonsustained ventricular tachycardia in 12, and sustained ventricular tachycardia in one. A decrease in systolic blood pressure of greater than 40 mm Hg or a peak systolic pressure of less than 80 mm Hg was present in eight cases. In the group with an ejection fraction of 25% or less, there was a higher rate of significant tachyarrhythmias (14% versus 5%; p = 0.03), whereas the feasibility of the test was slightly lower (89%; p < 0.01), but no difference for hypotension was found. By multivariate analysis, a history of tachyarrhythmias was the only predictor of stress-induced arrhythmias. Advanced left ventricular dysfunction does not represent a contraindication for dobutamine-atropine stress testing.
Cornel
J H
JH
Department of Cardiology, University Hospital Rotterdam-Dijkzigt, Erasmus University, The Netherlands.
Balk
A H
AH
Boersma
E
E
Maat
A P
AP
Elhendy
A
A
Arnese
M
M
Salustri
A
A
Roelandt
J R
JR
Fioretti
P M
PM
D000318:Adrenergic beta-Agonists / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000209:etiology; D001285:Atropine / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D006328:Cardiac Catheterization; D002303:Cardiac Output, Low / Q000000981:diagnostic imaging / Q000503:physiopathology; D000075202:Contraindications; D004280:Dobutamine / Q000009:adverse effects; D004452:Echocardiography / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007022:Hypotension / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018727:Muscarinic Antagonists / Q000009:adverse effects; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012449:Safety; D013312:Stress, Physiological / Q000503:physiopathology*; D013318:Stroke Volume; D013610:Tachycardia / Q000209:etiology; D017180:Tachycardia, Ventricular / Q000209:etiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology
D000318:Adrenergic beta-Agonists; D018727:Muscarinic Antagonists; D004280:Dobutamine; D001285:Atropine