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

Abstract

Background and AimBecause unstable angina has always been considered a contraindication for dobutamineatropine 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). Dobutamineatropine 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. ResultsNo 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 . 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 dobutamineatropine 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.

Dobutamine Stress Echo Is Superior to Exercise Stress Testing in Achieving Target Heart Rate among Patients on Beta Blockers

“…As previously reported, the diminished heart rate response with patients undergoing DSE with β-blockade may be attenuated with the addition of atropine [11, 12]. Similarly, we found a significant improvement in the rate of patients achieving THR with the administration of atropine.…”

“…The inherent sensitivity, specificity, and predictive value of a negative stress test are dependent on achieving THR. These are important in the prognostic assessment of patients that are subjected to stress testing as preoperative screening or prior to discharge after an ischemic event [12]. Many clinicians favor continuing β-blockers during preoperative stress testing in order to provide a more realistic predictor of clinical outcome.…”

Evaluating risk in unstable angina: role of pharmacological stress echocardiography

“…Plaque complexity and instability correlate more than the degree of obstruction with the risk of subsequent cardiac events [18] . In the study of Sitges et al [14] , the prognostic value of dobutamine stress echocardiography was greater than that obtained in the same population with other non-invasive tests.…”

“…Exercise echocardiography [12] or thallium-201 myocardial perfusion imaging [13] may also play a role in patients with unstable angina who respond to medical treatment. In this issue, Sitges and colleagues [14] demonstrate that dobutamine-atropine stress echocardiography performed in patients with unstable angina who remain asymptomatic after 48 h following hospital admission is safe and provides useful prognostic information.…”

Diretrizes da Sociedade Brasileira de Cardiologia sobre Angina Instável e Infarto Agudo do Miocárdio sem Supradesnível do Segmento ST: PARTE II Condutas nos Pacientes de Risco Intermediário e Alto

“…Sitges e cols. 113 estudaram 132 pacientes com diagnóstico de AI por ecocardiografia de estresse com dobutamina-atropina no 3º dia de internação hospitalar. Não houve complicações maiores relacionadas ao exame.…”