Feasibility and prognostic value of dobutamine-atropine stress echocardiography early in unstable angina.

Abstract

BACKGROUND AND AIM:

Because unstable angina has always been considered a contraindication for dobutamine-atropine stress echocardiography (DSE), the role of dobutamine-atropine stress echocardiography in unstable angina is unknown. Our aim was to assess the safety and prognostic value of dobutamine-atropine stress echocardiography in unstable angina.

METHODS:

One hundred and thirty-two patients were studied (mean age 64+/-12 years, 29 women). Dobutamine-atropine stress echocardiography was performed on the third day after hospital admission. End-points were unstable angina, myocardial infarction or cardiac death at 1 year follow-up.

RESULTS:

No major complications occurred during dobutamine-atropine stress echocardiography. Ninety-six (78%) patients were on beta-blocker therapy during the test; mean maximum heart rate achieved was 106+/-23 beats x min(-1). Nine of the 21 patients (43%) with a positive dobutamine-atropine stress echocardiography presented cardiac events during follow-up: two patients died, one had a myocardial infarction and six had recurrent class III-IV angina. Among 80 patients with negative dobutamine-atropine stress echocardiography, one (1%) had myocardial infarction and six patients (7.5%) had recurrent angina. Event-free survival after 1 year for patients with a negative dobutamine-atropine stress echocardiography for ischaemia was 91% compared to 57% for those with a positive dobutamine-atropine stress echocardiography (P<0. 0001). Left ventricular dysfunction (P=0.01), prior myocardial infarction (P=0.03) and a positive dobutamine-atropine stress echocardiography (P=0.004) were independent predictors of cardiac events during follow-up.

CONCLUSIONS:

Dobutamine-atropine stress echocardiography is safe in unstable angina if it is performed when patients remain asymptomatic for at least 48 h. A negative dobutamine-atropine stress echocardiogram for ischaemia predicts a good prognosis in medically treated patients with unstable angina and may allow their early discharge from hospital. Good prognostic information was obtained despite the use of beta-blockers and low heart rates during dobutamine-atropine stress echocardiography.

• Authors: M Sitges, C Paré, M Azqueta, X Bosch, F Miranda-Guardiola, M Velamazán, J Magriñá, G Sanz
• Journal: European heart journal (Eur Heart J) Vol. 21 Issue 13 Pg. 1063-71 (Jul 2000) ISSN: 0195-668X [Print] England
• PMID: 10843824 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright 2000 The European Society of Cardiology.

Chemical References

• Dobutamine
• Atropine

Topics

• Adult
• Aged
• Aged, 80 and over
• Angina, Unstable (diagnostic imaging, physiopathology)
• Atropine (administration & dosage)
• Dobutamine (administration & dosage)
• Echocardiography
• Electrocardiography
• Exercise Test
• Feasibility Studies
• Female
• Heart Rate
• Humans
• Infusions, Intravenous
• Male
• Middle Aged
• Prognosis
• Prospective Studies
• Recurrence