title: Prognostic value of dobutamine stress echocardiography with early injection of atropine with versus without chronic beta-blocker therapy in patients with known or suspected coronary heart disease.
abstract: Although a new protocol of dobutamine stress echocardiography with the early injection of atropine (EA-DSE) has been demonstrated to be useful in reducing adverse effects and increasing the number of effective tests and to have similar accuracy for detecting coronary artery disease (CAD) compared with conventional protocols, no data exist regarding its ability to predict long-term events. The aim of this study was to determine the prognostic value of EA-DSE and the effects of the long-term use of beta blockers on it. A retrospective evaluation of 844 patients who underwent EA-DSE for known or suspected CAD was performed; 309 (37%) were receiving beta blockers. During a median follow-up period of 24 months, 102 events (12%) occurred. On univariate analysis, predictors of events were the ejection fraction (p <0.001), male gender (p <0.001), previous myocardial infarction (p <0.001), angiotensin-converting enzyme inhibitor therapy (p = 0.021), calcium channel blocker therapy (p = 0.034), and abnormal results on EA-DSE (p <0.001). On multivariate analysis, the independent predictors of events were male gender (relative risk [RR] 1.78, 95% confidence interval [CI] 1.13 to 2.81, p = 0.013) and abnormal results on EA-DSE (RR 4.45, 95% CI 2.84 to 7.01, p <0.0001). Normal results on EA-DSE with beta blockers were associated with a nonsignificant higher incidence of events than normal results on EA-DSE without beta blockers (RR 1.29, 95% CI 0.58 to 2.87, p = 0.54). Abnormal results on EA-DSE with beta blockers had an RR of 4.97 (95% CI 2.79 to 8.87, p <0.001) compared with normal results, while abnormal results on EA-DSE without beta blockers had an RR of 5.96 (95% CI 3.41 to 10.44, p <0.001) for events, with no difference between groups (p = 0.36). In conclusion, the detection of fixed or inducible wall motion abnormalities during EA-DSE was an independent predictor of long-term events in patients with known or suspected CAD. The prognostic value of EA-DSE was not affected by the long-term use of beta blockers.
authors.affiliation: Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil. jeane.tsutsui@incor.usp.br
authors.forename: Jeane M
authors.initials: JM
authors.lastname: Tsutsui
authors.forename: Paulo M M
authors.initials: PM
authors.lastname: Dourado
authors.forename: Sandra N R S
authors.initials: SN
authors.lastname: Falcão
authors.forename: Magda
authors.initials: M
authors.lastname: Figueiredo
authors.forename: Vitor C
authors.initials: VC
authors.lastname: Guerra
authors.forename: Antônio C P
authors.initials: AC
authors.lastname: Chagas
authors.forename: Protásio L
authors.initials: PL
authors.lastname: Daluz
authors.forename: José A F
authors.initials: JA
authors.lastname: Ramires
authors.forename: Wilson
authors.initials: W
authors.lastname: Mathias
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D001285:Atropine / Q000008:administration & dosage*; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000319:Adrenergic beta-Antagonists; D001285:Atropine