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

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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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ASJC Scopus subject areas

  • Nursing(all)

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Pingitore, A., Picano, E., Colosso, M. Q., Reisenhofer, B., Gigli, G., Lucarini, A. R., Petix, N., Previtali, M., Bigi, R., Chiarandà, G., Minardi, G., De Alcantara, M., Lowenstein, J., Sclavo, M. G., Palmieri, C., Galati, A., Seveso, G., Heyman, J., Mathias, W., ... 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