title: Dobutamine stress echo is superior to exercise stress testing in achieving target heart rate among patients on beta blockers.
abstract: Published guidelines recommend continuing beta-adrenergic receptor blockade in patients undergoing stress testing. We evaluated the role of pharmacological versus exercise stress testing in achieving target heart rate (THR) among patients on beta-adrenergic blockade. We compared data from 140 patients who underwent dobutamine stress echo (DSE) and 143 patients who underwent exercise treadmill testing (ETT). In both groups, beta-adrenergic blocker was continued at the time of stress testing. Overall, patients undergoing DSE achieved THR more frequently than ETT. With beta-adrenergic blockade, DSE patients met THR more frequently than ETT patients (p < 0.001). Without beta-adrenergic blockade, there was no difference between either modality in achieving THR. In both DSE and ETT patients, absence of beta-adrenergic blockade increased the odds of achieving THR [odds ratio (OR): 2.46, p = 0.042 and OR: 7.44, p < 0.001, respectively]. Atropine use with DSE increased the odds of achieving THR (OR: 3.76, p = 0.006). In conclusion, pharmacological stress testing appears to be superior to exercise stress testing in achieving THR among patients on beta-adrenergic blockade.
authors.affiliation: Southern Arizona VA Health Care System, University of Arizona, Sarver Heart Center Tucson, 85723, USA. lvcactus@yahoo.com
authors.forename: Adam
authors.initials: A
authors.lastname: Sabbath
authors.forename: Michael
authors.initials: M
authors.lastname: Pack
authors.forename: Richard
authors.initials: R
authors.lastname: Markiewicz
authors.forename: Jooby
authors.initials: J
authors.lastname: John
authors.forename: Mohamed
authors.initials: M
authors.lastname: Gaballa
authors.forename: Steven
authors.initials: S
authors.lastname: Goldman
authors.forename: Hoang
authors.initials: H
authors.lastname: Thai
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage* / Q000493:pharmacokinetics; D000368:Aged; D015331:Cohort Studies; D003327:Coronary Disease / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D025401:Echocardiography, Stress; D005080:Exercise Test; D005260:Female; D006339:Heart Rate / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000319:Adrenergic beta-Antagonists