Safety of dobutamine-atropine stress echocardiography

A prospective experience of 4033 consecutive studies

Jr Mathias W., Adelaide M Arruda-Olson, F. C. Santos, A. L. Arruda, E. Mattos, A. Osorio, O. Campos, M. Gil, J. L. Andrade, A. C. Carvalho

Research output: Contribution to journalArticle

88 Citations (Scopus)

Abstract

Dobutamine-atropine stress echocardiography (DASE) is an established method and has been shown to be accurate for the detection of coronary artery disease. Still, there are few large clinical studies that analyze the safety of DASE in general or the safety of performing it on an ambulatory basis. Most studies use a target heart rate as the primary end point regardless of whether asymptomatic ischemia occurs. Such studies have shown a serious cardiac event rate of approximately 0.3%. We prospectively studied 4033 consecutive patients on an ambulatory basis and in the hospital with the use of DASE from July 1991 to December 1998. All tests were performed by an experienced physician, and all clinical and DASE data were stored in a large database organized at the beginning of the study. Dobutamine was infused in scalar doses of 5, 10, 20, 30, and 40 μg/kg per minute in 3-minute stages. Development of a new wall motion abnormality, achievement of 85% of target heart, and end of the DASE infusion protocol were used as an end point. If 85% of the target heart rate was not achieved, atropine was infused up to 1 mg in the absence of myocardial ischemia, which was used in 1280 studies. There were 3645 diagnostic tests, and 388 (10%) were found to be nondiagnostic. This result was due to poor image quality in 115 (3%), end of protocol in negative-submaximal examinations in 124 (3%), and limiting side effects in 149 (4%). Thirty-seven percent of the tests showed positive results for myocardial ischemia. Major test-related cardiac complications occurred in 10 (0.25%) patients and included 1 ventricular fibrillation, 1 case of myocardial infarction; and 8 cases of sustained ventricular tachycardia. Atropine poisoning was observed in 5 (0.12%) patients. No deaths occurred as a direct or indirect consequence of DASE. We conclude that dobutamine-atropine stress echocardiography is a reasonably safe method for detection of coronary artery disease in the hospital or in an ambulatory basis. The use of new wall motion abnormality as 1 of the end points may prevent further ischemia-related complications.

Original languageEnglish (US)
Pages (from-to)785-791
Number of pages7
JournalJournal of the American Society of Echocardiography
Volume12
Issue number10
DOIs
StatePublished - 1999
Externally publishedYes

Fingerprint

Stress Echocardiography
Atropine
Safety
Myocardial Ischemia
Coronary Artery Disease
Ischemia
Heart Rate
Dobutamine
Ventricular Fibrillation
Ventricular Tachycardia
Routine Diagnostic Tests
Poisoning
Myocardial Infarction
Databases
Physicians

ASJC Scopus subject areas

  • Medicine(all)
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Safety of dobutamine-atropine stress echocardiography : A prospective experience of 4033 consecutive studies. / Mathias W., Jr; Arruda-Olson, Adelaide M; Santos, F. C.; Arruda, A. L.; Mattos, E.; Osorio, A.; Campos, O.; Gil, M.; Andrade, J. L.; Carvalho, A. C.

In: Journal of the American Society of Echocardiography, Vol. 12, No. 10, 1999, p. 785-791.

Research output: Contribution to journalArticle

Mathias W., J, Arruda-Olson, AM, Santos, FC, Arruda, AL, Mattos, E, Osorio, A, Campos, O, Gil, M, Andrade, JL & Carvalho, AC 1999, 'Safety of dobutamine-atropine stress echocardiography: A prospective experience of 4033 consecutive studies', Journal of the American Society of Echocardiography, vol. 12, no. 10, pp. 785-791. https://doi.org/10.1016/S0894-7317(99)70182-3
Mathias W., Jr ; Arruda-Olson, Adelaide M ; Santos, F. C. ; Arruda, A. L. ; Mattos, E. ; Osorio, A. ; Campos, O. ; Gil, M. ; Andrade, J. L. ; Carvalho, A. C. / Safety of dobutamine-atropine stress echocardiography : A prospective experience of 4033 consecutive studies. In: Journal of the American Society of Echocardiography. 1999 ; Vol. 12, No. 10. pp. 785-791.
@article{2ba5edc3494f468292e5d25b3ccbaf20,
title = "Safety of dobutamine-atropine stress echocardiography: A prospective experience of 4033 consecutive studies",
abstract = "Dobutamine-atropine stress echocardiography (DASE) is an established method and has been shown to be accurate for the detection of coronary artery disease. Still, there are few large clinical studies that analyze the safety of DASE in general or the safety of performing it on an ambulatory basis. Most studies use a target heart rate as the primary end point regardless of whether asymptomatic ischemia occurs. Such studies have shown a serious cardiac event rate of approximately 0.3{\%}. We prospectively studied 4033 consecutive patients on an ambulatory basis and in the hospital with the use of DASE from July 1991 to December 1998. All tests were performed by an experienced physician, and all clinical and DASE data were stored in a large database organized at the beginning of the study. Dobutamine was infused in scalar doses of 5, 10, 20, 30, and 40 μg/kg per minute in 3-minute stages. Development of a new wall motion abnormality, achievement of 85{\%} of target heart, and end of the DASE infusion protocol were used as an end point. If 85{\%} of the target heart rate was not achieved, atropine was infused up to 1 mg in the absence of myocardial ischemia, which was used in 1280 studies. There were 3645 diagnostic tests, and 388 (10{\%}) were found to be nondiagnostic. This result was due to poor image quality in 115 (3{\%}), end of protocol in negative-submaximal examinations in 124 (3{\%}), and limiting side effects in 149 (4{\%}). Thirty-seven percent of the tests showed positive results for myocardial ischemia. Major test-related cardiac complications occurred in 10 (0.25{\%}) patients and included 1 ventricular fibrillation, 1 case of myocardial infarction; and 8 cases of sustained ventricular tachycardia. Atropine poisoning was observed in 5 (0.12{\%}) patients. No deaths occurred as a direct or indirect consequence of DASE. We conclude that dobutamine-atropine stress echocardiography is a reasonably safe method for detection of coronary artery disease in the hospital or in an ambulatory basis. The use of new wall motion abnormality as 1 of the end points may prevent further ischemia-related complications.",
author = "{Mathias W.}, Jr and Arruda-Olson, {Adelaide M} and Santos, {F. C.} and Arruda, {A. L.} and E. Mattos and A. Osorio and O. Campos and M. Gil and Andrade, {J. L.} and Carvalho, {A. C.}",
year = "1999",
doi = "10.1016/S0894-7317(99)70182-3",
language = "English (US)",
volume = "12",
pages = "785--791",
journal = "Journal of the American Society of Echocardiography",
issn = "0894-7317",
publisher = "Mosby Inc.",
number = "10",

}

TY - JOUR

T1 - Safety of dobutamine-atropine stress echocardiography

T2 - A prospective experience of 4033 consecutive studies

AU - Mathias W., Jr

AU - Arruda-Olson, Adelaide M

AU - Santos, F. C.

AU - Arruda, A. L.

AU - Mattos, E.

AU - Osorio, A.

AU - Campos, O.

AU - Gil, M.

AU - Andrade, J. L.

AU - Carvalho, A. C.

PY - 1999

Y1 - 1999

N2 - Dobutamine-atropine stress echocardiography (DASE) is an established method and has been shown to be accurate for the detection of coronary artery disease. Still, there are few large clinical studies that analyze the safety of DASE in general or the safety of performing it on an ambulatory basis. Most studies use a target heart rate as the primary end point regardless of whether asymptomatic ischemia occurs. Such studies have shown a serious cardiac event rate of approximately 0.3%. We prospectively studied 4033 consecutive patients on an ambulatory basis and in the hospital with the use of DASE from July 1991 to December 1998. All tests were performed by an experienced physician, and all clinical and DASE data were stored in a large database organized at the beginning of the study. Dobutamine was infused in scalar doses of 5, 10, 20, 30, and 40 μg/kg per minute in 3-minute stages. Development of a new wall motion abnormality, achievement of 85% of target heart, and end of the DASE infusion protocol were used as an end point. If 85% of the target heart rate was not achieved, atropine was infused up to 1 mg in the absence of myocardial ischemia, which was used in 1280 studies. There were 3645 diagnostic tests, and 388 (10%) were found to be nondiagnostic. This result was due to poor image quality in 115 (3%), end of protocol in negative-submaximal examinations in 124 (3%), and limiting side effects in 149 (4%). Thirty-seven percent of the tests showed positive results for myocardial ischemia. Major test-related cardiac complications occurred in 10 (0.25%) patients and included 1 ventricular fibrillation, 1 case of myocardial infarction; and 8 cases of sustained ventricular tachycardia. Atropine poisoning was observed in 5 (0.12%) patients. No deaths occurred as a direct or indirect consequence of DASE. We conclude that dobutamine-atropine stress echocardiography is a reasonably safe method for detection of coronary artery disease in the hospital or in an ambulatory basis. The use of new wall motion abnormality as 1 of the end points may prevent further ischemia-related complications.

AB - Dobutamine-atropine stress echocardiography (DASE) is an established method and has been shown to be accurate for the detection of coronary artery disease. Still, there are few large clinical studies that analyze the safety of DASE in general or the safety of performing it on an ambulatory basis. Most studies use a target heart rate as the primary end point regardless of whether asymptomatic ischemia occurs. Such studies have shown a serious cardiac event rate of approximately 0.3%. We prospectively studied 4033 consecutive patients on an ambulatory basis and in the hospital with the use of DASE from July 1991 to December 1998. All tests were performed by an experienced physician, and all clinical and DASE data were stored in a large database organized at the beginning of the study. Dobutamine was infused in scalar doses of 5, 10, 20, 30, and 40 μg/kg per minute in 3-minute stages. Development of a new wall motion abnormality, achievement of 85% of target heart, and end of the DASE infusion protocol were used as an end point. If 85% of the target heart rate was not achieved, atropine was infused up to 1 mg in the absence of myocardial ischemia, which was used in 1280 studies. There were 3645 diagnostic tests, and 388 (10%) were found to be nondiagnostic. This result was due to poor image quality in 115 (3%), end of protocol in negative-submaximal examinations in 124 (3%), and limiting side effects in 149 (4%). Thirty-seven percent of the tests showed positive results for myocardial ischemia. Major test-related cardiac complications occurred in 10 (0.25%) patients and included 1 ventricular fibrillation, 1 case of myocardial infarction; and 8 cases of sustained ventricular tachycardia. Atropine poisoning was observed in 5 (0.12%) patients. No deaths occurred as a direct or indirect consequence of DASE. We conclude that dobutamine-atropine stress echocardiography is a reasonably safe method for detection of coronary artery disease in the hospital or in an ambulatory basis. The use of new wall motion abnormality as 1 of the end points may prevent further ischemia-related complications.

UR - http://www.scopus.com/inward/record.url?scp=0032834445&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032834445&partnerID=8YFLogxK

U2 - 10.1016/S0894-7317(99)70182-3

DO - 10.1016/S0894-7317(99)70182-3

M3 - Article

VL - 12

SP - 785

EP - 791

JO - Journal of the American Society of Echocardiography

JF - Journal of the American Society of Echocardiography

SN - 0894-7317

IS - 10

ER -