title: Comparison of dobutamine and treadmill exercise echocardiography in inducing ischemia in patients with coronary artery disease.
abstract: OBJECTIVE
  We sought to compare the magnitude of ischemia precipitated by both treadmill exercise and dobutamine stress echocardiography.
  
  
  BACKGROUND
  Although it is alleged that dobutamine stress produces ischemia similar in degree and extent to that produced during treadmill exercise, a direct comparison with treadmill exercise, the most common form of exercise, has not been performed.
  
  
  METHODS
  Eighty-five consecutive patients with known coronary artery disease underwent both stress tests on the same day, in random order.
  
  
  RESULTS
  Sixty-two patients (73%) had positive results on exercise echocardiography compared with 53 (62%) who had positive results on dobutamine stress (p = NS). Of the 53 patients with positive dobutamine test results, wall motion abnormalities appeared after the addition of atropine in 35 patients (66%). During dobutamine infusion, 22 patients (26%) had a hypotensive response that was reversed in 16 by prompt administration of atropine. At peak dobutamine-atropine stress, heart rate was higher than that at peak exercise (p < 0.001), whereas systolic blood pressure and rate-pressure product were higher at peak exercise than at peak dobutamine-atropine stress (p = 0.0001). In the 53 patients with positive results on both tests, peak wall motion score index was greater with treadmill exercise than with dobutamine-atropine infusion ([mean +/- SD] 1.73 +/- 0.45 vs. 1.57 +/- 0.44, p < 0.001).
  
  
  CONCLUSIONS
  Echocardiography immediately after treadmill exercise induces a greater ischemic burden than dobutamine-atropine infusion. In the clinical setting, exercise echocardiography should therefore be chosen over dobutamine echocardiography for diagnosing ischemia, when possible. When dobutamine echocardiography is used as an alternative modality, maximal heart rate should always be achieved by the addition of atropine.
authors.affiliation: Department of Medicine, Hammersmith Hospital, London, England, United Kingdom.
authors.forename: L
authors.initials: L
authors.lastname: Rallidis
authors.forename: P
authors.initials: P
authors.lastname: Cokkinos
authors.forename: D
authors.initials: D
authors.lastname: Tousoulis
authors.forename: P
authors.initials: P
authors.lastname: Nihoyannopoulos
mesh_terms: D001285:Atropine; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D004280:Dobutamine; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000209:etiology
chemical_list: D004280:Dobutamine; D001285:Atropine