Copyright © 2000 by the European Society of Cardiology.
Feasibility and prognostic value of dobutamine–atropine stress echocardiography early in unstable angina
Cardiovascular Institute, Hospital Clínic, University of Barcelona, Spain
revised July 5, 1999; accepted July 27, 1999
Abstract
Background and Aim Because unstable angina has always been considered a contraindication for dobutamine–atropine stress echocardiography (DSE), the role of dobutamine–atropine stress echocardiography in unstable angina is unknown. Our aim was to assess the safety and prognostic value of dobutamine–atropine stress echocardiography in unstable angina.
Methods One hundred and thirty-two patients were studied (mean age 64±12 years, 29 women). Dobutamine–atropine stress echocardiography was performed on the third day after hospital admission. End-points were unstable angina, myocardial infarction or cardiac death at 1 year follow-up.
Results No major complications occurred during dobutamine–atropine stress echocardiography. Ninety-six (78%) patients were on beta-blocker therapy during the test; mean maximum heart rate achieved was 106±23 beats.min–1. Nine of the 21 patients (43%) with a positive dobutamine–atropine stress echocardiography presented cardiac events during follow-up: two patients died, one had a myocardial infarction and six had recurrent class III–IV angina. Among 80 patients with negative dobutamine–atropine stress echocardiography, one (1%) had myocardial infarction and six patients (7·5%) had recurrent angina. Event-free survival after 1 year for patients with a negative dobutamine–atropine stress echocardiography for ischaemia was 91% compared to 57% for those with a positive dobutamine–atropine stress echocardiography (P<0·0001). Left ventricular dysfunction (P=0·01), prior myocardial infarction (P=0·03) and a positive dobutamine–atropine stress echocardiography (P=0·004) were independent predictors of cardiac events during follow-up.
Conclusions Dobutamine–atropine stress echocardiography is safe in unstable angina if it is performed when patients remain asymptomatic for at least 48h. A negative dobutamine–atropine stress echocardiogram for ischaemia predicts a good prognosis in medically treated patients with unstable angina and may allow their early discharge from hospital. Good prognostic information was obtained despite the use of beta-blockers and low heart rates during dobutamine–atropine stress echocardiography.
Key Words: Unstable angina • prognosis • dobutamine stress echocardiography
f1 Correspondence: Carles Paré, Villarroel 170, 08036 Barcelona, Spain.
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