title: Early atropine is safer than conventional atropine administration in the elderly undergoing dobutamine stress echocardiography.
abstract: BACKGROUND
  Early injection of atropine during dobutamine stress echocardiography has been demonstrated in retrospective analyses to reduce the duration and dose of dobutamine infusion, while preserving a similar diagnostic accuracy with a lower incidence of adverse effects.
  
  
  OBJECTIVE
  In our prospective study, we sought to explore the safety of the early atropine-dobutamine stress echocardiography protocol compared to the conventional protocol in elderly patients.
  
  
  METHODS
  We enrolled 100 consecutive elderly patients who had been referred to our echocardiography laboratory for evaluation of myocardial ischemia. Once eligible, patients were randomly assigned to undergo either the conventional protocol (Group 1, 50 patients) or early atropine protocol (Group 2, 50 patients) where atropine was started at dobutamine infusion rate of 20 microg/kg/min if the heart rate was < 100 beats/min, and at 30 microg/kg/min if the heart rate was < 120 beats/min, (max 2.0 mg). Test duration and total dobutamine dose were calculated.
  
  
  RESULTS
  The mean age of the whole study cohort was 69.8 +/- 2.8 years, 54 (54%) being males. Patients in Group 1 received a higher total dose of dobutamine (15.7 +/- 0.8 vs 12.2 +/- 1.5 mg) and had a longer test duration (14.3 +/- 3.5 vs 11.5 +/- 1.3 min) as compared to Group 2 (p < 0.01 for both). The two groups received a similar total dose of atropine (NS). Group 1 patients had a higher incidence of ventricular extra-systoles, non-sustained ventricular tachycardia, atrial fibrillation, and hypotension.
  
  
  CONCLUSIONS
  In elderly patients undergoing dobutamine stress echocardiography, adopting the early atropine protocol offers a shorter test duration and a lower dobutamine dose, with consequently fewer adverse effects.
authors.affiliation: Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Zainab
authors.initials: Z
authors.lastname: Abdel-Salam
authors.forename: Wail
authors.initials: W
authors.lastname: Nammas
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology / Q000517:prevention & control; D001285:Atropine / Q000008:administration & dosage*; D004280:Dobutamine; D004334:Drug Administration Schedule; D025401:Echocardiography, Stress / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007022:Hypotension / Q000517:prevention & control; D008297:Male; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging*; D011292:Premedication; D011446:Prospective Studies; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000517:prevention & control
chemical_list: D004280:Dobutamine; D001285:Atropine