Safety of dobutamine-atropine stress myocardial perfusion scintigraphy.
Dobutamine stress testing is increasingly used for the diagnosis and functional evaluation of coronary artery disease. However, the relationship between myocardial perfusion abnormalities and complications of the test has not been studied.


METHODS
We studied the hemodynamic profile, safety and feasibility of dobutamine (up to 40 microg/kg/min)-atropine (up to 1 mg) stress myocardial perfusion SPECT imaging (with 201TI, 99mTc-MIBI or tetrofosmin) in a consecutive series of 1076 patients (age = 59 +/- 11 yr, 50% with previous myocardial infarction) referred for evaluation of myocardial ischemia.


RESULTS
No infarction or death occurred during the test. The test was considered feasible (achievement of 85% of the target heart rate or an ischemic endpoint) in 1005 patients (94%). Hypotension (systolic blood pressure drop > or = 40 mm Hg) occurred in 37 patients (3.4%). Independent predictors were higher baseline systolic blood pressure (p < 0.0001), number of ischemic segments (p < 0.05) and age (p < 0.05). Supraventricular tachyarrhythmias occurred in 48 patients (4.4%). Independent predictors were fixed perfusion defect (infarction) score (p < 0.005) and age (p < 0.05). Ventricular tachycardia occurred in 41 patients (3.8%). Independent predictors were infarction score (p < 0.01) and male gender (p < 0.05). All arrhythmias terminated spontaneously or after metoprolol administration.


CONCLUSIONS
Dobutamine-atropine myocardial perfusion scintigraphy is a feasible method for the evaluation of coronary artery disease with a safety profile and feasibility comparable to those reported for dobutamine stress echocardiography. Patients with more severe fixed perfusion abnormalities are at a higher risk of developing tachyarrhythmias during the test.
Elhendy
A
A
Thoraxcenter and Department of Nuclear Medicine, University Hospital Rotterdam-Dijkzigt, Erasmus University, Rotterdam, The Netherlands.
Valkema
R
R
van Domburg
R T
RT
Bax
J J
JJ
Nierop
P R
PR
Cornel
J H
JH
Geleijnse
M L
ML
Reijs
A E
AE
Krenning
E P
EP
Roelandt
J R
JR
D001285:Atropine; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D004280:Dobutamine; D005240:Feasibility Studies; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D007022:Hypotension / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D012307:Risk Factors; D012449:Safety; D013610:Tachycardia / Q000209:etiology; D017256:Technetium Tc 99m Sestamibi; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon
D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes; D004280:Dobutamine; C078700:technetium tc-99m tetrofosmin; D001285:Atropine; D017256:Technetium Tc 99m Sestamibi