Enhanced sensitivity for detection of coronary artery disease by addition of atropine to dobutamine stress echocardiography

McNeill, Albert J.; Fioretti, P.; El-Said, E. S. M.; Salustri, Alessandro; Forster, Tamás; Roelandt, Jos R.T.C.

doi:10.1016/0002-9149(92)91387-j

Cited by 376 publications

(129 citation statements)

References 18 publications

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“…[1][2][3][4][5][6][7][8] During conventional DASE, administration of atropine at peak dobutamine infusion is frequently required to reach target heart rate. 9,10 However, atropine may prolong study time and infrequently may cause serious side effects. 9,10 Thus, an alternative way of augmenting heart rate during DASE would be of significant clinical interest.…”

Section: Introductionmentioning

confidence: 99%

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Isometric handgrip exercise during dobutamine‐atropine stress echocardiography increases heart rate acceleration and decreases study duration and dobutamine and atropine dosage

Yao

Moldenhauer

Sherrid

2003

Clinical Cardiology

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SummaryBackground: Dobutamine-atropine stress echocardiography (DASE) is an established test for the diagnosis and risk stratification of patients with coronary artery disease. Atropine use to attain target heart rate prolongs test time.Hypothesis: The aim of this study was to assess the utility of isometric handgrip exercise (33% maximal voluntary contraction ϫ 4 min) with DASE.Methods: We prospectively evaluated 131 patients undergoing DASE randomized to handgrip exercise or no handgrip. Effect of handgrip exercise on endpoints: time to target heart rate (85% maximum predicted), recovery time, total test time, mean dobutamine and atropine dosage, and the number of ischemic responses were assessed. Effect of current beta-blocker medication use was also evaluated.Results: Heart rate rose more quickly in the handgrip group. At 6-10 min (peak handgrip), mean heart rate rose 51 ± 14 beats/min in the handgrip group compared with 38 ± 18 beats/min in the no handgrip group (p < 0.0001). With handgrip, overall dobutamine study time was reduced by a mean of 4.3 min (16.4 ± 6.9 vs. 20.7 ± 8.4, p = 0.004) in all patients, and by a mean of 5.9 min in patients not on beta-blocker medication (p = 0.001). The handgrip group also had a lower mean dose of dobutamine (25.8 ± 13.5 vs. 32.4 ± 16.4 mg, p = 0.025). The mean atropine dose was also lower (0.2 ± 0.4 vs.

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Section: Introductionmentioning

confidence: 99%

“…9,10 However, atropine may prolong study time and infrequently may cause serious side effects. 9,10 Thus, an alternative way of augmenting heart rate during DASE would be of significant clinical interest.…”

Section: Introductionmentioning

confidence: 99%

Isometric handgrip exercise during dobutamine‐atropine stress echocardiography increases heart rate acceleration and decreases study duration and dobutamine and atropine dosage

Yao

Moldenhauer

Sherrid

2003

Clinical Cardiology

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“…coronary artery stenosis [5][6][7][8][9]. However, high doses of dobutamine are necessary to detect CAD even in patients with critical coronary stenosis.…”

Section: Utility Of Combined Assessment Of Coronary Flow Velocity Andmentioning

confidence: 99%

Utility of Combined Assessment of Coronary Flow Velocity and Myocardial Perfusion During Low-dose Dobutamine Stress Echocardiography in the Detection of Left Anterior Coronary Artery Disease

Ohno¹,

Honma²,

Takayama³

et al. 2006

J Echocardiogr

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Background. Ischemia produces a sequence of events beginning with a decline in coronary flow reserve, myocardial perfusion abnormalities, and wall motion abnormalities. We hypothesized that low-dose dobutamine stress, combined with myocardial contrast echocardiography (MCE) and transthoracic Doppler echocardiography (TTDE), could detect myocardial ischemia preceding wall motion abnormalities according to this ischemic cascade.Methods. Ninety-six patients suspected of having stable angina pectoris underwent TTDE, MCE, and semi-quantitative dobutamine stress echocardiography (Semi-DSE). Wall motion was assessed using a scoring system. The contrast agent, Levovist, was injected intravenously to assess the coronary flow velocity (CFV) ratio in the left anterior descending coronary artery (LAD) and myocardial perfusion abnormalities in the LAD territory. The CFV ratio was calculated as the CFV during low-dose dobutamine stress divided by the baseline CFV. Time-intensity data for MCE were fitted for y = A (1 e t ) from which the rate of the intensity rise ( ) was calculated and the ratio was derived at baseline and during stress.Results. Semi-DSE and low-dose dobutamine stress combined with TTDE and MCE were obtained successfully in 85patients. The sensitivity and specificity of Semi-DSE for detecting 75% LAD stenosis were 79% and 93%, respectively. In the LAD territory, Semi-DSE showed 6 false negative and 4 false positive findings. However, failures of the CFV ratio and ratio to increase >1.81 and >1.23 times that at baseline, respectively, indicated the presence of critical LAD stenosis, especially in 3 out of 6 false negative cases.Conclusions. Low-dose dobutamine stress combined with TTDE and MCE is a useful method for detecting critical LAD stenosis during Semi-DSE. This method overcomes the limitations of Semi-DSE. (J Echocardiogr 2006; 4: 69-77)

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“…For the subjects without ischemic symptoms (Angina pectoris, ST segment elevation or depression > 1 mm, wall motion abnormality) and those who could not achieve the target heart rate [(220-age) × 0.85] at the last stage, the procedure was extended to 6 minutes and 0.25-1 mg of atropine was added during the dobutamine infusion. 8,9) Angiographic analysis: All of the cases with ischemia in myocardial perfusion imaging underwent coronary angiography and ventriculography within 24 hours of the echocardiographic assessments. The coronary angiograms and left ventriculograms of the study group were analyzed by invasive cardiologists without knowledge of the echocardiographic data.…”

Section: )mentioning

confidence: 99%

Usefulness of Pulse-wave Doppler Tissue Sampling and Dobutamine Stress Echocardiography for Identification of False Positive Inferior Wall Defects in SPECT.

et al. 2000

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SUMMARYFalse positive inferior wall perfusion defects restrict the accuracy of SPECT in diagnosis of coronary artery disease (CAD). Pulse-Wave Tissue Doppler (PWTD) has been recently proposed to assess regional wall motion velocities. The objectives of this study were to evaluate the presence of CAD by using PWTD during dobutamine stress echocardiography (DSE) in patients with an inferior perfusion defect detected by SPECT and compare PWTD parameters of normal cases with patients who had inferior perfusion defect and CAD.Sixty-five patients (mean age 58 ± 8 years, 30 men) with a normal LV systolic function at rest according to echocardiographic evaluation with an inferior ischemia determined by SPECT and a control group (CG) of 34 normal cases (mean age 56 ± 7 years, 16 men) were included in this study. All patients underwent a standard DSE (up to 40 µg / kg / min with additional atropine during sub-maximum heart rate responses). Pulse-wave Doppler tissue sampling of inferior wall was performed in the apical 2-chamber view at rest and stress. The coronary angiography was performed within 24 hours. The results were evaluated for the prediction of significant right coronary artery (RCA) and / or left circumflex coronary artery (CX) with narrowing (≥ 50 % diameter stenosis, assessed by quantitative coronary angiography).It was observed that the peak stress mean E / A ratio was lower in patients

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Enhanced sensitivity for detection of coronary artery disease by addition of atropine to dobutamine stress echocardiography

Cited by 376 publications

References 18 publications

Isometric handgrip exercise during dobutamine‐atropine stress echocardiography increases heart rate acceleration and decreases study duration and dobutamine and atropine dosage

Isometric handgrip exercise during dobutamine‐atropine stress echocardiography increases heart rate acceleration and decreases study duration and dobutamine and atropine dosage

Utility of Combined Assessment of Coronary Flow Velocity and Myocardial Perfusion During Low-dose Dobutamine Stress Echocardiography in the Detection of Left Anterior Coronary Artery Disease

Usefulness of Pulse-wave Doppler Tissue Sampling and Dobutamine Stress Echocardiography for Identification of False Positive Inferior Wall Defects in SPECT.

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