ABSTRACT
Although dobutamine-atropine stress echocardiography (DASE) is an established method for evaluating patients who have coronary artery disease (CAD), it can increase test duration and a patient's exposure to large doses of dobutamine. New protocols, including the early injection of atropine during dobutamine stress echocardiography (EA-DSE), have been proposed to decrease test duration. This study compared the safety, efficacy, and accuracy of EA-DSE with those of DASE. We retrospectively evaluated 3,163 patients who underwent DASE and 1,664 patients who underwent EA-DSE over a period of 12 years. In EA-DSE, atropine at a dose =2 mg was started with 20 microg/kg/min of dobutamine if heart rate was <100 beats/min. Diagnostic accuracy for detecting CAD (>50% stenosis) was assessed in patients who underwent quantitative angiography =3 months of stress testing. The dobutamine dose used in EA-DSE was smaller than that used in DASE (31 +/- 6 vs 36 +/- 6 microg/kg/min, p <0.0001), although the atropine dose was larger (0.8 +/- 0.5 vs 0.5 +/- 0.25 mg, p <0.0001). EA-DSE resulted in a significantly shorter duration of dobutamine infusion (12.4 +/- 2.0 vs 14.6 +/- 2.5 minutes, p <0.0001), more diagnostic studies (88% vs 81%, p <0.0001), and a lower incidence of minor adverse effects than did DASE. The rate of major adverse effects was similar in the 2 protocols. Sensitivities, specificities, positive predictive values, negative predictive values, and accuracies for detecting CAD were 84%, 90%, 93%, 76%, and 86% for EA-DSE and 86%, 78%, 84%, 79%, and 82% for DASE, respectively (p = NS). Therefore, EA-DSE is a safe and effective alternative to DASE and had a similar accuracy for the detection of CAD.
Subject(s)
Anti-Arrhythmia Agents/administration & dosage , Anti-Arrhythmia Agents/adverse effects , Atropine/administration & dosage , Atropine/adverse effects , Coronary Artery Disease/diagnostic imaging , Echocardiography, Stress/methods , Aged , Anti-Arrhythmia Agents/therapeutic use , Atropine/therapeutic use , Drug Administration Schedule , Female , Heart Rate/drug effects , Humans , Male , Middle Aged , Predictive Value of Tests , Retrospective Studies , Sensitivity and SpecificityABSTRACT
RESUMO: Objetivo: Determinar a segurança, eficácia, e acurácia diagnóstica da infusão precoce de atropina durante a ecocardiografia sob estresse peladobutamina (AP-EED), em comparação com o protocolo convencional de dobutamina-atropina (EEDA), em pacientes com doença arterial coronariana (DAC) conhecida ou suspeita. Introdução: Embora a EEDA seja um método bem estabelecido para avaliar pacientes com DAC, pode resultar em longa duração do teste e exposição dos pacientes a altas doses de dobutamina. Novos protocolos, incluindo AP-EED, têm sido propostos para reduzir aduração do teste. Métodos: Estudamos retrospectivamente 3163 pacientes submetidos a EEDA e 1664 pacientes submetidos a AP-EED, em um período de 12 anos. No protocolo EEDA, atropina foi injetada apenas na dose máxima de dobutamina, enquanto na AP-EED atropina foi iniciada com 20mcg/Kg/min de dobutamina se a freqüência cardíaca estivesse <100 bpm, até 2mg. A acurácia diagnóstica para detecção de DAC (estenose >50 por cento em >_1 artéria coronariana) foi avaliada em pacientes que realizaram angiografia quantitativa dentro de três meses após o ecocardiograma sob estresse. Resultados: A dose total de dobutamina utilizada na AP-EED foi menor que na EEDA (31+- 6 verso 36 +- 6 mcg/Kg/min;p<0,OOO1), enquanto a dose de atropina foi maior (0,8+-0,5 verso 0,5+-0,25 mg; p<0,0001). Com AP-EED houve redução significativa da duração do teste (12,4+-2,0 verso 14,6+-2,5 minutos;p<0,OO01), maior porcentagem de testes eficazes (88 por cento verso 81 por cento;pSubject(s)
Humans
, Male
, Atropine/adverse effects
, Atropine/therapeutic use
, Echocardiography, Stress/adverse effects
, Echocardiography, Stress/methods
, Coronary Angiography/methods
, Myocardial Ischemia/diagnosis
, Myocardial Ischemia/therapy