The atropine factor in pharmacologic stress echocardiography

Alessandro Pingitore, Eugenio Picano, Massimo Quarta Colosso, Barbara Reisenhofer, Guido Gigli, Alessandra R. Lucarini, Nunzia Petix, Mario Previtali, Riccardo Bigi, Giacomo Chiarandà, Giovanni Minardi, Monica De Alcantara, Jorge Lowenstein, Maria Grazia Sclavo, Cataldo Palmieri, Alfonso Galati, Gianni Seveso, Joanna Heyman, Wilson Mathias, Franco CasazzaRosa Sicari, Mauro Raciti, Patrizia Landi, Mario Marzilli

Research output: Contribution to journalArticle

Abstract

Objectives. This study sought to compare, head to head, the two most popular pharmacologic stress echocardiographic tests - dipyridamole and dobutamine - with state of the art protocols in a large multicenter prospective study. Background. In the continuing quest for ideal diagnostic accuracy, pharmacologic stress echocardiography has quickly moved over the years from low to high dose regimens and is currently performed with atropine coadministration. Methods. Dobutamine (up to 40 μg/kg body weight per min) plus atropine (up to 1 mg over 4 h) and dipyridamole (up to 0.84 mg/kg per min over 10 h) plus atropine (up to 1 mg over 4 h) stress echocardiography was performed on different days, in random order and within 1 week in 360 patients with chest pain syndrome. Thirteen different echocardiographic laboratories, all fulfilling quality control criteria for stress echocardiographic reading, contributed to the study. Results. No major complications occurred during either test. The test was interrupted before achievement of predetermined end points for limiting side effects in 37 dobutamine-atropine and 7 dipyridamole-atropine stress echocardiographic studies (feasibility 90% vs. 98%, p <0.01). Diagnostic accuracy was assessed in a subset of 110 patients with no obvious rest dyssynergy (akinesia or dyskinesia) who underwent coronary angiography independently of test results and within 1 week of testing. Significant coronary artery disease (≥50% diameter reduction in at least one major coronary vessel by quantitative coronary angiography) was found in 92 patients. Sensitivity for detection of coronary artery disease was 84% (77 of 92) for dobutamine-atropine and 82% (75 of 92) for dipyridamole-atropine stress echocardiography (p = NS), with a specificity of 89% (16 of 18) for dobutamine-atropine and 94% (17 of 18) for dipyridamole-atropine stress echocardiography (p = NS). A significant correlation was present between peak wall motion score index during dipyridamole-atropine and dobutamine-atropine stress echocardiography (r = 0.83, p <0.0001). Conclusions. Dobutamine-atropine and dipyridamole-atropine stress echocardiography are safe and feasible, although submaximal studies are more frequent with dobutamine. The two stresses have comparable accuracy in the detection of angiographically assessed coronary artery disease, although dobutamine is marginally more sensitive and dipyridamole marginally more specific. Stratification of the ischemic response in the space domain is also comparable with the two stresses.

Original languageEnglish
Pages (from-to)1164-1170
Number of pages7
JournalJournal of the American College of Cardiology
Volume27
Issue number5
DOIs
Publication statusPublished - Apr 1996

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Stress Echocardiography
Atropine
Dobutamine
Dipyridamole
Coronary Artery Disease
Coronary Angiography
Dyskinesias
Feasibility Studies
Chest Pain
Exercise Test
Quality Control
Multicenter Studies
Reading

ASJC Scopus subject areas

  • Nursing(all)

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Pingitore, A., Picano, E., Colosso, M. Q., Reisenhofer, B., Gigli, G., Lucarini, A. R., ... Marzilli, M. (1996). The atropine factor in pharmacologic stress echocardiography. Journal of the American College of Cardiology, 27(5), 1164-1170. https://doi.org/10.1016/0735-1097(95)00586-2

The atropine factor in pharmacologic stress echocardiography. / Pingitore, Alessandro; Picano, Eugenio; Colosso, Massimo Quarta; Reisenhofer, Barbara; Gigli, Guido; Lucarini, Alessandra R.; Petix, Nunzia; Previtali, Mario; Bigi, Riccardo; Chiarandà, Giacomo; Minardi, Giovanni; De Alcantara, Monica; Lowenstein, Jorge; Sclavo, Maria Grazia; Palmieri, Cataldo; Galati, Alfonso; Seveso, Gianni; Heyman, Joanna; Mathias, Wilson; Casazza, Franco; Sicari, Rosa; Raciti, Mauro; Landi, Patrizia; Marzilli, Mario.

In: Journal of the American College of Cardiology, Vol. 27, No. 5, 04.1996, p. 1164-1170.

Research output: Contribution to journalArticle

Pingitore, A, Picano, E, Colosso, MQ, Reisenhofer, B, Gigli, G, Lucarini, AR, Petix, N, Previtali, M, Bigi, R, Chiarandà, G, Minardi, G, De Alcantara, M, Lowenstein, J, Sclavo, MG, Palmieri, C, Galati, A, Seveso, G, Heyman, J, Mathias, W, Casazza, F, Sicari, R, Raciti, M, Landi, P & Marzilli, M 1996, 'The atropine factor in pharmacologic stress echocardiography', Journal of the American College of Cardiology, vol. 27, no. 5, pp. 1164-1170. https://doi.org/10.1016/0735-1097(95)00586-2
Pingitore A, Picano E, Colosso MQ, Reisenhofer B, Gigli G, Lucarini AR et al. The atropine factor in pharmacologic stress echocardiography. Journal of the American College of Cardiology. 1996 Apr;27(5):1164-1170. https://doi.org/10.1016/0735-1097(95)00586-2
Pingitore, Alessandro ; Picano, Eugenio ; Colosso, Massimo Quarta ; Reisenhofer, Barbara ; Gigli, Guido ; Lucarini, Alessandra R. ; Petix, Nunzia ; Previtali, Mario ; Bigi, Riccardo ; Chiarandà, Giacomo ; Minardi, Giovanni ; De Alcantara, Monica ; Lowenstein, Jorge ; Sclavo, Maria Grazia ; Palmieri, Cataldo ; Galati, Alfonso ; Seveso, Gianni ; Heyman, Joanna ; Mathias, Wilson ; Casazza, Franco ; Sicari, Rosa ; Raciti, Mauro ; Landi, Patrizia ; Marzilli, Mario. / The atropine factor in pharmacologic stress echocardiography. In: Journal of the American College of Cardiology. 1996 ; Vol. 27, No. 5. pp. 1164-1170.
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title = "The atropine factor in pharmacologic stress echocardiography",
abstract = "Objectives. This study sought to compare, head to head, the two most popular pharmacologic stress echocardiographic tests - dipyridamole and dobutamine - with state of the art protocols in a large multicenter prospective study. Background. In the continuing quest for ideal diagnostic accuracy, pharmacologic stress echocardiography has quickly moved over the years from low to high dose regimens and is currently performed with atropine coadministration. Methods. Dobutamine (up to 40 μg/kg body weight per min) plus atropine (up to 1 mg over 4 h) and dipyridamole (up to 0.84 mg/kg per min over 10 h) plus atropine (up to 1 mg over 4 h) stress echocardiography was performed on different days, in random order and within 1 week in 360 patients with chest pain syndrome. Thirteen different echocardiographic laboratories, all fulfilling quality control criteria for stress echocardiographic reading, contributed to the study. Results. No major complications occurred during either test. The test was interrupted before achievement of predetermined end points for limiting side effects in 37 dobutamine-atropine and 7 dipyridamole-atropine stress echocardiographic studies (feasibility 90{\%} vs. 98{\%}, p <0.01). Diagnostic accuracy was assessed in a subset of 110 patients with no obvious rest dyssynergy (akinesia or dyskinesia) who underwent coronary angiography independently of test results and within 1 week of testing. Significant coronary artery disease (≥50{\%} diameter reduction in at least one major coronary vessel by quantitative coronary angiography) was found in 92 patients. Sensitivity for detection of coronary artery disease was 84{\%} (77 of 92) for dobutamine-atropine and 82{\%} (75 of 92) for dipyridamole-atropine stress echocardiography (p = NS), with a specificity of 89{\%} (16 of 18) for dobutamine-atropine and 94{\%} (17 of 18) for dipyridamole-atropine stress echocardiography (p = NS). A significant correlation was present between peak wall motion score index during dipyridamole-atropine and dobutamine-atropine stress echocardiography (r = 0.83, p <0.0001). Conclusions. Dobutamine-atropine and dipyridamole-atropine stress echocardiography are safe and feasible, although submaximal studies are more frequent with dobutamine. The two stresses have comparable accuracy in the detection of angiographically assessed coronary artery disease, although dobutamine is marginally more sensitive and dipyridamole marginally more specific. Stratification of the ischemic response in the space domain is also comparable with the two stresses.",
author = "Alessandro Pingitore and Eugenio Picano and Colosso, {Massimo Quarta} and Barbara Reisenhofer and Guido Gigli and Lucarini, {Alessandra R.} and Nunzia Petix and Mario Previtali and Riccardo Bigi and Giacomo Chiarand{\`a} and Giovanni Minardi and {De Alcantara}, Monica and Jorge Lowenstein and Sclavo, {Maria Grazia} and Cataldo Palmieri and Alfonso Galati and Gianni Seveso and Joanna Heyman and Wilson Mathias and Franco Casazza and Rosa Sicari and Mauro Raciti and Patrizia Landi and Mario Marzilli",
year = "1996",
month = "4",
doi = "10.1016/0735-1097(95)00586-2",
language = "English",
volume = "27",
pages = "1164--1170",
journal = "Journal of the American College of Cardiology",
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TY - JOUR

T1 - The atropine factor in pharmacologic stress echocardiography

AU - Pingitore, Alessandro

AU - Picano, Eugenio

AU - Colosso, Massimo Quarta

AU - Reisenhofer, Barbara

AU - Gigli, Guido

AU - Lucarini, Alessandra R.

AU - Petix, Nunzia

AU - Previtali, Mario

AU - Bigi, Riccardo

AU - Chiarandà, Giacomo

AU - Minardi, Giovanni

AU - De Alcantara, Monica

AU - Lowenstein, Jorge

AU - Sclavo, Maria Grazia

AU - Palmieri, Cataldo

AU - Galati, Alfonso

AU - Seveso, Gianni

AU - Heyman, Joanna

AU - Mathias, Wilson

AU - Casazza, Franco

AU - Sicari, Rosa

AU - Raciti, Mauro

AU - Landi, Patrizia

AU - Marzilli, Mario

PY - 1996/4

Y1 - 1996/4

N2 - Objectives. This study sought to compare, head to head, the two most popular pharmacologic stress echocardiographic tests - dipyridamole and dobutamine - with state of the art protocols in a large multicenter prospective study. Background. In the continuing quest for ideal diagnostic accuracy, pharmacologic stress echocardiography has quickly moved over the years from low to high dose regimens and is currently performed with atropine coadministration. Methods. Dobutamine (up to 40 μg/kg body weight per min) plus atropine (up to 1 mg over 4 h) and dipyridamole (up to 0.84 mg/kg per min over 10 h) plus atropine (up to 1 mg over 4 h) stress echocardiography was performed on different days, in random order and within 1 week in 360 patients with chest pain syndrome. Thirteen different echocardiographic laboratories, all fulfilling quality control criteria for stress echocardiographic reading, contributed to the study. Results. No major complications occurred during either test. The test was interrupted before achievement of predetermined end points for limiting side effects in 37 dobutamine-atropine and 7 dipyridamole-atropine stress echocardiographic studies (feasibility 90% vs. 98%, p <0.01). Diagnostic accuracy was assessed in a subset of 110 patients with no obvious rest dyssynergy (akinesia or dyskinesia) who underwent coronary angiography independently of test results and within 1 week of testing. Significant coronary artery disease (≥50% diameter reduction in at least one major coronary vessel by quantitative coronary angiography) was found in 92 patients. Sensitivity for detection of coronary artery disease was 84% (77 of 92) for dobutamine-atropine and 82% (75 of 92) for dipyridamole-atropine stress echocardiography (p = NS), with a specificity of 89% (16 of 18) for dobutamine-atropine and 94% (17 of 18) for dipyridamole-atropine stress echocardiography (p = NS). A significant correlation was present between peak wall motion score index during dipyridamole-atropine and dobutamine-atropine stress echocardiography (r = 0.83, p <0.0001). Conclusions. Dobutamine-atropine and dipyridamole-atropine stress echocardiography are safe and feasible, although submaximal studies are more frequent with dobutamine. The two stresses have comparable accuracy in the detection of angiographically assessed coronary artery disease, although dobutamine is marginally more sensitive and dipyridamole marginally more specific. Stratification of the ischemic response in the space domain is also comparable with the two stresses.

AB - Objectives. This study sought to compare, head to head, the two most popular pharmacologic stress echocardiographic tests - dipyridamole and dobutamine - with state of the art protocols in a large multicenter prospective study. Background. In the continuing quest for ideal diagnostic accuracy, pharmacologic stress echocardiography has quickly moved over the years from low to high dose regimens and is currently performed with atropine coadministration. Methods. Dobutamine (up to 40 μg/kg body weight per min) plus atropine (up to 1 mg over 4 h) and dipyridamole (up to 0.84 mg/kg per min over 10 h) plus atropine (up to 1 mg over 4 h) stress echocardiography was performed on different days, in random order and within 1 week in 360 patients with chest pain syndrome. Thirteen different echocardiographic laboratories, all fulfilling quality control criteria for stress echocardiographic reading, contributed to the study. Results. No major complications occurred during either test. The test was interrupted before achievement of predetermined end points for limiting side effects in 37 dobutamine-atropine and 7 dipyridamole-atropine stress echocardiographic studies (feasibility 90% vs. 98%, p <0.01). Diagnostic accuracy was assessed in a subset of 110 patients with no obvious rest dyssynergy (akinesia or dyskinesia) who underwent coronary angiography independently of test results and within 1 week of testing. Significant coronary artery disease (≥50% diameter reduction in at least one major coronary vessel by quantitative coronary angiography) was found in 92 patients. Sensitivity for detection of coronary artery disease was 84% (77 of 92) for dobutamine-atropine and 82% (75 of 92) for dipyridamole-atropine stress echocardiography (p = NS), with a specificity of 89% (16 of 18) for dobutamine-atropine and 94% (17 of 18) for dipyridamole-atropine stress echocardiography (p = NS). A significant correlation was present between peak wall motion score index during dipyridamole-atropine and dobutamine-atropine stress echocardiography (r = 0.83, p <0.0001). Conclusions. Dobutamine-atropine and dipyridamole-atropine stress echocardiography are safe and feasible, although submaximal studies are more frequent with dobutamine. The two stresses have comparable accuracy in the detection of angiographically assessed coronary artery disease, although dobutamine is marginally more sensitive and dipyridamole marginally more specific. Stratification of the ischemic response in the space domain is also comparable with the two stresses.

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