Comparison of safety and efficacy of the early injection of atropine during dobutamine stress echocardiography with the conventional protocol
Section snippets
Patients
We retrospectively analyzed a large databank that contained information about patients who had known or suspected CAD and were referred for dobutamine stress echocardiography. From July 1991 to December 1999, 3,369 patients underwent DASE. From January 2000 to June 2003, 1,984 patients underwent EA-DSE. Exclusion criteria were contraindications to any drug used in the study protocol,2 age <18 years, and submaximal tests performed for evaluation of myocardial viability. Cardioactive medications
Dobutamine and atropine doses
The dose of dobutamine used for EA-DSE was significantly smaller than that used for DASE (31 ± 6 vs 36 ± 6 μg/kg/min, respectively; p <0.0001). For EA-DSE, using 40 μg/kg/min of dobutamine was required to reach the study end points in only 328 patients (20%). In contrast, for DASE, 2,179 patients (69%) required this dose (p <0.0001 vs EA-DSE). The proportion of patients who received atropine during stress testing was larger for EA-DSE than for DASE (83% vs 33%, p <0.01), as was the mean dose of
Discussion
In the present study, we describe a comparison between EA-DASE and DASE performed in a systematic way in a large number of patients (4,827 examinations). EA-DSE required smaller doses of dobutamine and resulted in lower rates of minor adverse effects compared with DASE. Importantly, for EA-DSE, the incidence of major adverse effects remained low, similar to those reported previously.1, 16, 17 Conventional administration of atropine at peak doses of dobutamine may lead to rapid increases in
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This study was supported by institutional grants from the Heart Institute, University of São Paulo Medical School, São Paulo, Brazil.