Comparison between accelerated and conventional dobutamine stress protocols for myocardial perfusion scintigraphy

Abstract

The conventional dobutamine (Dob) stress protocol for myocardial perfusion scintigraphy (MPS) is long, with frequent adverse effects, and generally requires atropine injection to reach target heart rate. Atropine is usually administered at the end of the protocol, when adverse effects are more frequent. Earlier atropine injection may be useful to shorten the stress protocol and reduce adverse effects. We sought to compare a Dob stress protocol with early atropine injection to a conventional Dob stress protocol in the same patients undergoing MPS. 30 patients underwent Dob-MPS with a conventional protocol (steps of 10, 20, 30 and 40 mcg/kg/min at 3 min intervals, adding atropine to the maximal Dob dose if necessary to achieve 85% of the age-corrected maximal predicted heart rate) and with an accelerated protocol with early atropine injection (at the end of the first stage). We compared stress duration, maximal heart rate (HR), percentage of maximal predicted HR, rate-pressure product, ST changes, MPS scores and the incidence of adverse effects between the 2 protocols. The accelerated protocol was shorter than the conventional protocol (7.1 ± 3.4 min vs. 11.8 ± 1.3 min; P < 0.0001), had the same efficacy to achieve hemodynamic parameters, without increasing adverse effects. The summed stress scores obtained by automatic analysis were similar in both protocols (6.3 ± 6.3 vs. 6.8 ± 6.3; P = NS) as well as the summed difference scores (2.5 ± 3.6 vs. 2.7 ± 3.4; P = NS). Early atropine injection during dobutamine stress protocol shortens stress duration. Our results suggest that patient safety and accuracy of MPS are unaltered, when compared to the conventional protocol, but further, larger studies are still necessary.

Atualização da Diretriz Brasileira de Cardiologia Nuclear – 2020

“…Estudo nacional demonstrou que o uso precoce de atropina (após a primeira fase de infusão de dobutamina) é seguro, reduz o tempo de infusão e as queixas durante o estresse, sem afetar a precisão diagnóstica. 75 Adicionalmente, a presença de defeitos perfusionais induzidos pelo estresse farmacológico e anormalidades desencadeadas da motilidade agregam valor prognóstico incremental à prova, validadas recentemente com a utilização de câmaras ultrarrápidas (tecnologia CZT). 76 As contraindicações para o uso da dobutamina encontram-se na Tabela 14.…”