Safety and cardiac chronotropic responsiveness to the early injection of atropine during dobutamine stress echocardiography in the elderly

Abstract

Objective: To determine the safety and cardiac chronotropic responsiveness to early atropine dobutamine stress echocardiography (DSE) in the elderly. Design: Retrospective study of 258 patients > 70 years who underwent early atropine DSE and 290 patients > 70 years who underwent conventional DSE. In the early atropine protocol, atropine was started at 20 mg/kg/min of dobutamine if heart rate was , 100 beats/min, up to 2 mg. The cardiac chronotropic responsiveness in the elderly was compared with a control group of patients , 70 years matched for sex, myocardial infarction, diabetes, and treatment with b blockers and calcium channel blockers.Results: The dose of dobutamine given to elderly patients was lower during early atropine than during conventional DSE (mean (SD) 29 (7) v 38 (4) mg/kg/min, p = 0.001). Early atropine DSE resulted in diminished incidence of ventricular extrasystoles, non-sustained ventricular tachycardia, bradycardia, and hypotension compared with conventional DSE. In comparison with patients , 70 years, elderly patients required lower doses of dobutamine and atropine and achieved a higher percentage of predicted maximum heart rate (92 (9)% v 88 (10)%, p = 0.0001). Except for more common hypotension (16% v 10%, p = 0.004), no other difference in adverse effects was observed between patients > 70 and , 70 years. Conclusions: Early atropine DSE is a safe strategy in the elderly resulting in lower incidence of minor adverse effects than with the conventional protocol. Elderly patients presented adequate cardiac chronotropic responsiveness to early injections of atropine, requiring lower doses of drugs to reach test end points.

Effect of Atropine-dobutamine Stress Test on Left Ventricular Echocardiographic Parameters in Untrained Warmblood Horses

“…The ability of the dobutamine stress test to detect myocardial ischemia is dependent on an adequate increase in myocardial oxygen consumption, which is directly related to the HR achieved during stress. 10 Achievement of a high HR seems to be essential for the ability of the stress test to detect cardiac dysfunction. 5 In the study of Frye et al 5 , mean postexercise HR reached 160 bpm, whereas in the studies of Marr et al 3 and Sampson et al 11 , mean postexercise HR at the time of exercise stress echocardiography was 97 bpm and 112 bpm, respectively.…”

Incremental Value of Perfusion over Wall‐Motion Abnormalities with the Use of Dobutamine–Atropine Stress Myocardial Contrast Echocardiography and Magnetic Resonance Imaging for Detecting Coronary Artery Disease

“…Atropine (up to 2.0 mg) was injected in patients without symptoms or signs of myocardial ischemia at the stage of 20 μg/kg per minute when heart rate was less than 100 bpm. In cases in which heart rate had already achieved 100 bpm at this stage, atropine injection was postponed at the discretion of operating physician . Blood pressure and cardiac rhythm were continuously monitored prior to and during dobutamine infusion.…”

“…In cases in which heart rate had already achieved 100 bpm at this stage, atropine injection was postponed at the discretion of operating physician. 15,16 Blood pressure and cardiac rhythm were continuously monitored prior to and during dobutamine infusion. Endpoints of stress were achievement of the target heart rate (85% of predicted maximal heart rate), development of severe or extensive WM abnormalities, ST elevation >0.1 mV at an interval of 80 msec after the J-point in non-Qwave leads, or intolerable side effects.…”

Dynamic Changes in Microcirculatory Blood Flow during Dobutamine Stress Assessed by Quantitative Myocardial Contrast Echocardiography

“…Atropine (up to 2.0 mg) was injected in patients without symptoms or signs of myocardial ischemia at the stage of 20 μg/kg/min when heart rate (HR) was less than 100 beats/min. In cases in which HR had already achieved 100 beats/min at this stage, atropine injection was postponed at the discretion of operating physician 5, 7 . Immediately after acquisition of peak stress images, 5 mg of metoprolol were injected rapidly, in one minute, upon termination of dobutamine infusion 8 .…”

“…Recent reports have demonstrated some advantages in modifications of the conventional protocol of dobutamine stress. In this regard, early injection of atropine is a useful strategy for increasing test feasibility maintaining diagnostic and prognostic values 5–7 . Additionally, rapid injection of beta‐blocker at peak stress has been demonstrated to enhance detection of single‐vessel CAD 8, 9 .…”