Atropine increases the accuracy of dobutamine stress echocardiography in patients taking beta-blockers

• Published in: European heart journal 1994-03, Vol.15 (3), p.355-360
• Main Authors: FIORETTI, P. M, POLDERMANS, D, SALUSTRI, A, FORSTER, T, BELLOTTI, P, BOERSMA, E, MCNEILL, A. J, EL-SAID, E. S. M, ROELANDT, J. R. T. C
• Format: Article
• Language: English
• Subjects: Aged; Angina Pectoris - diagnostic imaging; Angina Pectoris - drug therapy; Angina Pectoris - physiopathology; Atropine - pharmacology; Biological and medical sciences; Cardiovascular system; Dobutamine - antagonists & inhibitors; Dobutamine - pharmacology; Drug Synergism; Echocardiography - drug effects; Echocardiography - methods; Electrocardiography - drug effects; Exercise Test; Female; Heart Rate - drug effects; Hemodynamics; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Metoprolol - pharmacology; Metoprolol - therapeutic use; Middle Aged; Myocardial Ischemia - diagnostic imaging; Myocardial Ischemia - physiopathology; Myocardial Ischemia - prevention & control; Prospective Studies; Ultrasonic investigative techniques
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/oxfordjournals.eurheartj.a060503

Dobutamine-atropine stress echocardiography is used for the non-invasive diagnosis of coronary artery disease, but stress test results may be influenced by beta-blockers. The aim of this study was to assess if the addition of atropine can compensate for the presence of beta-blockers in dobutamine stress echocardiography. Twenty-six patients referred for evaluation of chest pain were studied twice, on and off metoprolol 100 mg b.i.d. (in random order sequence) with a wash-out period of at least 48 h. Dobutamine stress echocardiography was performed using up to 40 micrograms.kg-1.min-1, followed, if necessary, by the addition of atropine to achieve 85% of the age-predicted maximal heart rate, unless symptoms or markers of ischaemia appeared. Atropine was given to patients on beta-blockers more often [(22/26) vs (6/26)] than to those off beta-blockers (P < 0.001). Heart rate at every stage of the test was lower on beta-blockers. Chest pain occurred in patients on beta-blockers significantly less than in those off beta-blockers (8% vs 46%), and the addition of atropine made no significant difference (31% vs 46%). During dobutamine stress, new wall motion abnormalities occurred in three patients on beta-blockers (12%); this number increased to 15 after the addition of atropine (57%). New or worsened wall motion abnormalities occurred in 12 patients (46%) off beta-blockers with dobutamine alone and in 14 patients after adding atropine (53%).