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December 12, 1994

Dobutamine-Atropine Stress Echocardiography in Elderly Patients Unable to Perform an Exercise Test: Hemodynamic Characteristics, Safety, and Prognostic Value

Author Affiliations

From the Department of Vascular Surgery (Drs Poldermans and van Urk) and the Thoraxcenter (Drs Fioretti, Boersma, Thomson, Cornel, ten Cate, Arnese, and Roelandt), University Hospital Rotterdam-Dijkzigt and Erasmus University, Rotterdam, the Netherlands.

Arch Intern Med. 1994;154(23):2681-2686. doi:10.1001/archinte.1994.00420230066008

Objective:  To establish the hemodynamic effects, safety, and prognostic value of dobutamine-atropine stress echocardiography in patients 70 years of age or older.

Design and Setting:  Observational study at a university hospital.

Patients:  One hundred seventy-nine patients (mean age, 75 years; range, 70 to 90 years) referred for chest pain (n=73) or preoperative risk assessment for major vascular noncardiac surgery (n=106).

Measurements:  All patients underwent clinical evaluation and dobutamine-atropine stress test.

Results:  One hundred seventy-nine stress tests were performed. Test end points were the target heart rate (85% of theoretical maximum heart rate), reached in 165 tests (92%); inadequate echo images, two tests (1%); and side effects, 12 tests (7%). Side effects that caused a premature end of the test were severe chest pain (n=5 [2.8%]), electrocardiographic changes (n=1 [0.6%]), hypotension (n=2 [1.1%]), chills (n=2 [1.1%]), and cardiac arrhythmias (paroxysmal atrial fibrillation) (n=2 [1.1%]). New wall motion abnormalities as a marker of myocardial ischemia occurred in 50 tests (28%). No death or myocardial infarction occurred during the test. Perioperative events occurred in 12 patients (four cardiac deaths, three myocardial infarctions, and five episodes of unstable angina). During 16±6 months (mean±SD) of follow-up of 166 patients, 22 cardiac events occurred (eight cardiac deaths, four myocardial infarctions, and 10 episodes of unstable angina pectoris). By multivariate regression analysis, only perioperative cardiac events (odds ratio, 51; 95% confidence interval, 5.8 to 454) and late cardiac events (odds ratio, 5.2; 95% confidence interval, 2.0 to 14) were correlated with new wall motion abnormalities during stress.

Conclusion:  Dobutamine-atropine stress echocardiography is a feasible and safe test for assessing elderly patients with suspected and/or proven coronary artery disease, providing useful prognostic information for perioperative and late cardiac risk with relatively few side effects.(Arch Intern Med. 1994;154:2681-2686)

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