title: Safety and feasibility of high-dose dobutamine-atropine stress cardiovascular magnetic resonance for diagnosis of myocardial ischaemia: experience in 1000 consecutive cases.
abstract: OBJECTIVE
  To determine the safety of high-dose dobutamine-atropine stress cardiovascular magnetic resonance (stress-CMR), which recently emerged as a highly accurate modality for diagnosis of inducible myocardial ischaemia.
  
  
  RESULTS
  From 1997 to 2002, 1000 consecutive stress-CMR examinations were performed. Images were acquired at rest and during a high-dose dobutamine-atropine protocol in 3 short-axis, a 4- and a 2-chamber view. Stress testing was discontinued when > or =85% of age-predicted heart rate was reached, on patient request, maximum pharmacologic infusion, or when new or worsening wall motion abnormalities, severe angina, dyspnoea, increase or decrease in blood pressure, or severe arrhythmias occurred. Stress-CMR was successfully performed in all but four patients (0.4%; insufficient ECG-triggering). Target heart rate was not reached in 95 cases (9.5%), due to maximum pharmacologic infusion in submaximal negative examinations in 21 cases (2.1%), and limiting side effects in 74 (7.4%). Side effects included one case (0.1%) of sustained and four cases (0.4%) of non-sustained ventricular tachycardia, 16 cases (1.6%) of atrial fibrillation, and two cases (0.2%) of transient second degree AV block.
  
  
  CONCLUSIONS
  The safety profile of stress-CMR is similar to other methodologies using dobutamine infusions. Patients must be closely monitored, and resuscitation equipment and trained personnel must be available.
authors.affiliation: Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Wahl
authors.forename: Ingo
authors.initials: I
authors.lastname: Paetsch
authors.forename: Albrecht
authors.initials: A
authors.lastname: Gollesch
authors.forename: Stefan
authors.initials: S
authors.lastname: Roethemeyer
authors.forename: Daniela
authors.initials: D
authors.lastname: Foell
authors.forename: Rolf
authors.initials: R
authors.lastname: Gebker
authors.forename: Holger
authors.initials: H
authors.lastname: Langreck
authors.forename: Christoph
authors.initials: C
authors.lastname: Klein
authors.forename: Eckart
authors.initials: E
authors.lastname: Fleck
authors.forename: Eike
authors.initials: E
authors.lastname: Nagel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001285:Atropine / Q000009:adverse effects; D002316:Cardiotonic Agents / Q000009:adverse effects; D004280:Dobutamine / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis*
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine; D001285:Atropine