Copyright © 1997 by the European Society of Cardiology.
© 1997 The European Society of Cardiology
Effects of antianginal therapy with a calcium antagonist and nitrates on dobutamine—atropine stress echocardiography
Comparison with exercise electrocardiography
Guastalla Hospital, Reggio Emilia and CNR, Institute of Clinical Physiology Pisa, Italy
revised 30 April 1996; accepted 2 May 1996.
Correspondence: Claudio Dodi. MD. Reparto di Cardiologia, Ospedale Civile di Guastalla (RE), Via Donatori di Sangue. 1, 42016 Guastalla, Reggio Emilia, Italy
Abstract
BACKGROUND: Anti-ischaemic therapy with nitrates and/or calcium channel blockers profoundly affects the results of pharmacological stress echocardiography with coronary vasodilators but the influence on catecholamine stress testing remains unsettled.
AIMS: The present study aimed to assess the effects of non-beta-blocker antianginal therapy on dobutamine (up to 40 µg.kg–1.min–1)-atropine (up to 1 mg) stress echocardiography and to evaluate whether drug-induced changes in the dobutamine-atropine stress echocardiography response may predict variations in exercise tolerance.
METHODS: Twenty six patients with angiographically assessed coronary artery disease (seven patients with single-, 10 with double-, and nine with triple-vessel disease) performed a dobutamine-atropine stress echocardiography and an exercise electrocardiography test in random order both off and on antianginal drugs (nitrates and calcium antagonists). In dobutamine-atropine stress echocardiography, we evaluated: dobutamine time (i.e. the time from initiation of the dobutamine infusion to obvious dyssynergy), wall motion score index (in a 16-segment model of the left ventricle, each segment ranging from 1=normal, to 4=dyskinetic), and rate-pressure product at peak stress.
RESULTS: Dobutamine-atropine stress echocardiography positivity occurred in 26 out of 26 patients off and in 23 patients on therapy (100 vs 88%, P=ns). Atropine coadministration was needed to evoke echo positivity in no patient off and in five out of 26 on therapy (0 vs 19%, P<0·01). The achieved rate-pressure product during dobutamine-atropine stress echocardiography was comparable on and off therapy (17±4 vs 19±5x103 mmHgxheart rate. min–1, Pns). Therapy induced an increase in dobutamine time (on=16±3 vs off=13±3 min, P<0·01) and a decrease in peak wall motion score index (on=1·3±0·2 vs off=1·5±0·3, P<0·01). The therapy-induced changes in exercise time during the exercise electrocardiography test were not significantly correlated to dobutamine-atropine stress echocardiography variations in either dobutamine time (r=0·07, P=ns), or peak rate-pressure product (r=0·24, P=ns), or peak wall motion score index (r=0·02, P=ns).
CONCLUSION: (1) non-beta-blocker antianginal therapy only modestly reduces dobutamine-atropine stress echocardiography sensitivity, although atropine coadministration is more often required to reach stress echo positivity under therapy; (2) therapy reduces the severity of dobutamine-atropine stress echocardiography ischaemia stratified in the time and space domain, but these changes are only poorly correlated to variations in exercise tolerance.
Key Words: Dobutamine • echocardiography • ischaemia • stress
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