[Safety and feasibility of dobutamine-atropine stress echocardiography in octogenarian patients].
OBJECTIVE
To assess the feasibility and safety of dobutamine-atropine stress echocardiography (DASE) in octogenarians.


METHODS
We evaluated 5,467 DASE which were distributed in two groups: group I (GI) with 203 DASE performed in octogenarians, and group II (GII), the control group, with 5,264 DASE. The mean age of GI and GII was 83 +/- 3 (80-95) and 59 +/- 11 (17-79) years, respectively. DASE parameters that were prospectively collected, were compared and analyzed.


RESULTS
The percentage of patients that achieved maximum heart rate was 63.5% in GI and 41% in GII (p < 0.001), and GI patients required less atropine compared to GII (GI = 47%, GII = 78%, p < 0.001). The presence of chest pain (GI = 13%, GII = 15.6%, p = 0.429) and DASE positive for myocardial ischemia (GI = 20.7%, GII = 16.9%, p = 0.296) were not statistically different between the two groups. However, concomitant positive DASE and absence of chest pain (GI = 17%, GII = 11%, p = 0.029) was higher in GI. The incidence of premature beats in GI was higher than in GII (GI = 47.8%, GII = 27.6%, p < 0.001), and there were more supraventricular tachyarrhythmias (ST) in GI than in GII (GI = 5.9%, GII = 1.9%, p = 0.001). Out of 11 ST that happened in GI, 9 reverted spontaneously. There weren't either deaths or acute myocardial infarction. Ventricular fibrillation only happened in GII (2 cases, 0.03%).


CONCLUSIONS
In the present study, octogenarians achieved maximum heart rate more frequently despite the lesser amount of atropine that they required for DASE completion. Moreover, in this elderly population, there was a higher correlation between positive DASE and absence of chest pain. Although octogenarians did present more heart rhythm disturbs, they usually resolved spontaneously. In our study, DASE proved to be feasible and safe in octogenarians.
Abreu
José Sebastião de
JS
Prontocárdio de Fortaleza, CE. jsabreu@cardiol.br
Diógenes
Tereza Cristina Pinheiro
TC
Farias
Ana Gardenia Liberato Ponte
AG
Morais
José Maria Bonfim de
JM
Paes Júnior
José Nogueira
JN
D000369:Aged, 80 and over; D001285:Atropine / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D002316:Cardiotonic Agents / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging; D004280:Dobutamine / Q000009:adverse effects; D025401:Echocardiography, Stress / Q000009:adverse effects / Q000592:standards*; D004812:Epidemiologic Methods; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging*; D010146:Pain / Q000139:chemically induced; D017678:Sex Distribution
D002316:Cardiotonic Agents; D004280:Dobutamine; D001285:Atropine