Safety of dobutamine-atropine stress echocardiography: A prospective experience of 4033 consecutive studies

Safety of dobutamine-atropine stress echocardiography: A prospective experience of 4033 consecutive studies

Autor Mathias, W. Google Scholar
Arruda, A. Google Scholar
Santos, F. C. Google Scholar
Arruda, A. L. Google Scholar
Mattos, E. Google Scholar
Osorio, A. Google Scholar
Campos, O. Google Scholar
Gil, M. Google Scholar
Andrade, J. L. Google Scholar
Carvalho, A. C. Google Scholar
Instituição Universidade Federal de São Paulo (UNIFESP)
Exata Diagnost
Resumo Dobutamine-atropine stress echocardiography (DASE) is an established method and has been shown to be accurate for the detection of coronary artery disease. Still, there are few large clinical studies that analyze the safety of DASE in general of the safety of performing it on an ambulatory basis. Most studies use a target heart rate as the primary end point regardless of whether asymptomatic ischemia occurs. Such studies have shown a serious cardiac event rate of approximately 0.3%. We prospectively studied 4033 consecutive patients on an ambulatory basis and in the hospital with the use of DASE from July 1991 to December 1998. All tests were performed by an experienced physician, and all clinical and DASE data were stored in a large database organized at the beginning of the study. Dobutamine was infused in scalar doses of 5, 10, 20, 30, and 40 mu g/kg per minute in 3-minute stages. Development of a new wall motion abnormality, achievement of 85% of target heart, and end of the DASE infusion protocol were used as an end point. If 85% of the target heart rate was not achieved, atropine was infused up to 1 mg in the absence of myocardial ischemia, which was used in 1280 studies. There were 3645 diagnostic tests, and 388 (10%) were found to be nondiagnostic. This result was due to poor image quality in 115 (3%), end of protocol in negative-submaximal examinations in 124 (3%), and limiting side effects in 149 (4%). Thirty-seven percent of the tests showed positive results for myocardial ischemia. Major test-related cardiac complications occurred in 10 (0.25%) patients and included 1 ventricular fibrillation, 1 case of myocardial infarction, and 8 cases of sustained ventricular tachycardia. Atropine poisoning was observed in 5 (0.12%) patients. No deaths occurred as a direct or indirect consequence of DASE. We conclude that dobutamine-atropine stress echocardiography is a reasonably safe method for detection of coronary artery disease in the hospital or in an ambulatory basis. the use of new wall motion abnormality as 1 of the end points may prevent further ischemia-related complications.
Idioma Inglês
Data de publicação 1999-10-01
Publicado em Journal of the American Society of Echocardiography. St Louis: Mosby-year Book Inc, v. 12, n. 10, p. 785-791, 1999.
ISSN 0894-7317 (Sherpa/Romeo, fator de impacto)
Publicador Mosby-year Book Inc
Extensão 785-791
Fonte http://dx.doi.org/10.1016/S0894-7317(99)70182-3
Direito de acesso Acesso restrito
Tipo Artigo
Web of Science WOS:000083255200003
Endereço permanente http://repositorio.unifesp.br/handle/11600/26152

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