title: Safety and feasibility of dobutamine-atropine stress echocardiography for the diagnosis of coronary artery disease in diabetic patients unable to perform an exercise stress test.
abstract: OBJECTIVE
  Dobutamine stress testing is increasingly used for the diagnosis and functional evaluation of coronary artery disease. However, little is known about the safety and feasibility of this stress modality in diabetic patients.
  
  
  METHODS
  We studied the impact of diabetes on hemodynamic profile and on the safety and feasibility of dobutamine (up to 40 microg x kg(-1) x min(-1)) and atropine (up to 1 mg) stress echocardiography for the diagnosis of coronary artery disease in 1,446 consecutive patients (aged 60+/-12 years, 962 men) with limited exercise capacity and suspected myocardial ischemia. Of these, 184 patients were known to have IDDM or NIDDM. The test was considered feasible when 85% of the maximal heart rate and/or an ischemic end point (new or worsened wall motion abnormalities, ST segment depression, or angina) was achieved.
  
  
  RESULTS
  No myocardial infarction or death occurred during the test. There was no significant difference between diabetic and nondiabetic patients with regard to heart rate increase during dobutamine stress echocardiography (58+/-25 vs. 61+/-24 beats/min), peak rate pressure product (18,400+/-3,135 vs. 18,048+/-4454), or the prevalence of hypotension (systolic blood pressure drop of >40 mmHg) (7 vs. 5%), ventricular tachycardia (5.4 vs. 4.5%), and supraventricular tachycardia (3 vs. 4%) during the test. Dobutamine stress echocardiography was feasible in 92% of the diabetic patients and in 90% of the nondiabetic patients. Coronary angiography was performed in 55 diabetic and 240 nondiabetic patients. Sensitivity, specificity, and accuracy of dobutamine stress echocardiography for the diagnosis of coronary artery disease in diabetic patients were 81, 85, and 82%. Those in nondiabetic patients were 74, 87, and 77%, respectively (NS).
  
  
  CONCLUSIONS
  Dobutamine stress echocardiography is a feasible method for the diagnosis of coronary artery disease in patients with limited exercise capacity with a comparable safety, feasibility, and accuracy in diabetic and nondiabetic patients.
authors.affiliation: Thoraxcenter, University Hospital Rotterdam-Dijkzigt, Erasmus University, Rotterdam, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Elhendy
authors.forename: R T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: D
authors.initials: D
authors.lastname: Poldermans
authors.forename: J J
authors.initials: JJ
authors.lastname: Bax
authors.forename: P R
authors.initials: PR
authors.lastname: Nierop
authors.forename: M L
authors.initials: ML
authors.lastname: Geleijnse
authors.forename: J R
authors.initials: JR
authors.lastname: Roelandt
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000139:chemically induced; D001285:Atropine; D001794:Blood Pressure / Q000187:drug effects; D002316:Cardiotonic Agents; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis*; D003925:Diabetic Angiopathies / Q000150:complications / Q000175:diagnosis*; D004280:Dobutamine; D004452:Echocardiography / Q000379:methods; D005080:Exercise Test; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine; D001285:Atropine