Skip Navigation

European Heart Journal 2000 21(5):397-406; doi:10.1053/euhj.1999.1860
Copyright © 2000 by the European Society of Cardiology.
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (29)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Geleijnse, M.L
Right arrow Articles by Simoons, M.L
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Geleijnse, M.L
Right arrow Articles by Simoons, M.L
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Safety and prognostic value of early dobutamine–atropine stress echocardiography in patients with spontaneous chest pain and a non-diagnostic electrocardiogram

M.L Geleijnsef1, A Elhendy, J.D Kasprzak, R Rambaldi, R.T Van Domburg, J.H Cornel, A.P.J Klootwijk, P.M Fioretti, J.R.T.C Roelandt and M.L Simoons

Thoraxcentre, University Hospital Rotterdam-Dijkzigt, Rotterdam, The Netherlands
Erasmus University, Rotterdam, The Netherlands

revised July 9, 1999; accepted July 20, 1999

Abstract

Aims To risk stratify and shorten hospital stay in patients with spontaneous (resting) chest pain and a non-diagnostic electrocardiogram (ECG).

Methods and Results The study comprised 102 patients (mean age 58±12 years, 67 men) with spontaneous chest pain and a non-diagnostic ECG. Forty-three patients had suspected coronary artery disease and 59 had known (but of unknown actual significance) coronary artery disease. All patients underwent serial creatine kinase enzyme measurements, continuous ECG monitoring for at least 12h and early dobutamine–atropine stress echocardiography in patients with negative creatine kinase enzymes and normal findings at ECG monitoring. Dobutamine–atropine stress echocardiography was considered positive in patients with new or worsening wall thickening abnormalities. Patients with negative dobutamine–atropine stress echocardiography were discharged after the test. In-hospital and 6 month follow-up events noted were cardiac death, non-fatal myocardial infarction, unstable angina, and coronary artery bypass surgery or angioplasty. Thirteen patients had evidence of evolving myocardial infarction by elevated creatine kinase enzymes, or unstable angina by ECG monitoring. In the remaining 89 patients, dobutamine–atropine stress echocardiography was performed after a median observation period of 31h (range 12–68h). During dobutamine–atropine stress echocardiography no serious complications (death, non-fatal myocardial infarction, sustained ventricular tachycardia or ventricular fibrillation) occurred. Dobutamine–atropine stress echocardiography results were of poor quality in three, non-diagnostic in six, negative in 44 and positive in 36 patients. In the 80 patients with diagnostic dobutamine–atropine stress echocardiography, variables associated with in-hospital events (n=7) were history of exertional angina (P<0·005), chest pain score (P<0·005), stress-induced angina (P<0·001) and positive dobutamine–atropine stress echocardiography (P<0·005). Variables associated with follow-up events (n=11) were history of exertional angina (P<0·05), chest pain score (P<0·001), stress-induced angina (P<0·01) and positive dobutamine–atropine stress echocardiography (P<0·01). At multivariate analysis the only significant predictor of events was positive dobutamine–atropine stress echocardiography (P<0·01).

Conclusion Early dobutamine–atropine stress echocardiography may safely distinguish between low- and high-risk subsets for subsequent cardiac events in patients with spontaneous chest pain and a non-diagnostic ECG.

Key Words: Dobutamine • stress echocardiography • coronary artery disease • spontaneous chest pain

f1 Correspondence: Marcel L Geleijnse MD, Thoraxcentre, Room Ba 302, Dr Molewaterplein 40, 3015 GD Rotterdam The Netherlands.

References

  1. Pozen MW, D'Agostino RB, Selker HP, Sytkowski PA, Hood WB. A predictive instrument to improve coronary-care-unit admission practices in acute ischemic heart disease. N Engl J Med. 1984;310:1273–1278[Abstract]
  2. Lee TH, Juarez G, Cook FE. Ruling out acute myocardial infarction. A prospective multicenter validation of a 12-hour strategy for patients at low risk. N Engl J Med. 1991;324:1239–1246[Abstract]
  3. Sabia P, Abbott RD, Afrookteh A, Keller MW, Touchstone DA, Kaul S. Importance of two-dimensional echocardiographic assessment of left ventricular systolic function in patients presenting to the emergency room with cardiac-related symptoms. Circulation. 1991;84:1615–1624[Abstract/Free Full Text]
  4. Wackers FJ, Lie KI, Liem KL. Thallium-201 Scintigraphy in unstable angina pectoris. Circulation. 1978;57:738–743[Abstract/Free Full Text]
  5. Varetto T, Cantalupi D, Altieri A, Orlandi C. Emergency room Technetium-99m sestamibi imaging to rule out acute myocardial ischemic events in patients with nondiagnostic electrocardiograms. J Am Coll Cardiol. 1993;22:1804–1808[Abstract]
  6. Hilton TC, Thompson RC, Williams HJ, Saylors R, Fulmer H, Stowers SA. Technetium-99m sestamibi myocardial perfusion imaging in the emergency room evaluation of chest pain. J Am Coll Cardiol. 1994;23:1016–1022[Abstract]
  7. McCarthy BD, Beshansky JR, D'Agostino RB, Selker HP. Missed diagnosis of acute myocardial infarction in the emergency department: results from a multicenter study. Ann Emerg Med. 1993;22:579–582[CrossRef][ISI][Medline]
  8. Lee TH, Rouan GW, Weisberg MC. Clinical characteristics and natural history of patients with acute myocardial infarction sent home from the emergency room. Am J Cardiol. 1987;60:219–224[CrossRef][ISI][Medline]
  9. Lee TH, Goodman L. The coronary care unit turns 25: historical trends and future directions. Ann Intern Med. 1988;108:887–894[ISI][Medline]
  10. Geleijnse ML, Fioretti PM, Roelandt JRTC. Methodology, feasibility, safety, and diagnostic accuracy of dobutamine stress echocardiography: A review. J Am Coll Cardiol. 1997;30:595–606[Abstract]
  11. Geleijnse ML, Elhendy A, Cornel JH. Cardiac imaging for risk stratification with dobutamine-atropine stress testing in patients with chest pain. Echocardiography, perfusion scintigraphy, or both? Circulation. 1997;96:137–147[Abstract/Free Full Text]
  12. Trippi JA, Lee KS, Kopp G, Nelson DR, Yee KG, Cordell WH. Dobutamine stress tele-echocardiography for evaluation of emergency patients with chest pain. J Am Coll Cardiol. 1997;30:627–632[Abstract]
  13. Braunwald E. Unstable angina. A classification. Circulation. 1989;80:410–414[Free Full Text]
  14. Klootwijk P, Langer A, Meij S. Non-invasive prediction of reperfusion and coronary artery patency by continuous ST segment monitoring in the GUSTO-I trial. Eur Heart J. 1996;17:689–698[Abstract/Free Full Text]
  15. Reiber JHC, Serruys PW, Kooijman. Assessment of short-, medium-, and long-term variations in arterial dimensions from computer-assisted quantitation of coronary cineangiograms. Circulation. 1985;71:280–288[Abstract/Free Full Text]
  16. Dixon WJ. BMDP Statistical Software. Berkeley: University of California Press; 1992. p. 1105–44
  17. Gibler WB, Young GP, Hedges JR. Acute myocardial infarction in chest pain patients with nondiagnostic ECGs: Serial creatine kinase-MB sampling in the emergency department. Ann Emerg Med. 1992;21:504–512[CrossRef][ISI][Medline]
  18. Krucoff MW, Green CE, Satler LF. Noninvasive detection of coronary artery patency using continuous ST-segment monitoring. Am J Cardiol. 1986;57:916–922[CrossRef][ISI][Medline]
  19. Gibler WB, Sayre MR, Levy RC. Serial 12-lead electrocardiographic monitoring in patients presenting to the emergency department with chest pain. J Electrocardiol. 1994;26:238–243[CrossRef]
  20. Pandian NG, Skorton DJ, Collins SM, Falsetti HL, Burke ER, Kerber RE. Heterogeneity of left ventricular segmental wall thickening and excursion in 2-dimensional echocardiograms of normal human subjects. Am J Cardiol. 1983;51:1667–1673[CrossRef][ISI][Medline]
  21. Panza JA, Curiel RV, Laurienzo JM, Quyyumi AA, Dilsizian V. Relation between ischemic threshold measured during dobutamine stress echocardiography and known indices of poor prognosis in patients with coronary artery disease. Circulation. 1995;92:2095–2101[Abstract/Free Full Text]
  22. Nesto RW, Kowalchuck GJ. The ischemic cascade: temporal sequence of hemodynamic, electrocardiographic and symptomatic expressions of ischemia. Am J Cardiol. 1987;57:23C–27C
  23. van Miltenburg, AJM, Management policies and prognosis in unstable angina pectoris, Erasmus University Rotterdam, 1992
  24. Dargie HJ. Guidelines for cardiac exercise testing. Eur Heart J. 1993;14:969–988[Free Full Text]
  25. Lewis WR, Amsterdam EA. Utility and safety of immediate exercise testing of low-risk patients admitted to the hospital for suspected acute myocardial infarction. Am J Cardiol. 1994;74:987–990[CrossRef][ISI][Medline]
  26. Kerns JR, Shaub TF, Fontanarosa PB. Emergency cardiac stress testing in the evaluation of emergency department patients with atypical chest pain. Ann Emerg Med. 1993;22:36–40
  27. Gibler WB, Runyon JP, Levy RC. A rapid diagnostic and treatment center for patients with chest pain the emergency department. Ann Emerg Med. 1995;25:1–8[CrossRef][ISI][Medline]
  28. Lee TH, Cook EF, Weisberg M, Sargent RK, Wilson C, Goldman L. Acute chest pain in the emergency room. Identification and examination of low-risk patients. Arch Intern Med. 1985;145:65–69[Abstract]
  29. Hamm CW, Goldmann BU, Heeschen C, Kreymann G, Berger J, Meinertz T. Emergency room triage of patients with acute chest pain by means of rapid testing for cardiac troponin T or troponin I. N Engl J Med. 1997;337:1648–1653[Abstract/Free Full Text]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 Eur J EchocardiogrHome page
R. Sicari, P. Nihoyannopoulos, A. Evangelista, J. Kasprzak, P. Lancellotti, D. Poldermans, J.-U. Voigt, J. L. Zamorano, and on behalf of the European Association of Echocardi
Stress echocardiography expert consensus statement: European Association of Echocardiography (EAE) (a registered branch of the ESC)
Eur J Echocardiogr, July 1, 2008; 9(4): 415 - 437.
[Abstract] [Full Text] [PDF]

Home page
 HeartHome page
J Sanchis, X Bosch, V Bodi, N Bellera, J Nunez, B Benito, J Ordonez, L Consuegra, M Heras, and A Llecer
Combination of clinical risk profile, early exercise testing and circulating biomarkers for evaluation of patients with acute chest pain without ST-segment deviation or troponin elevation
Heart, March 1, 2008; 94(3): 311 - 315.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
E. Eroglu, J. D'hooge, L. Herbots, D. Thijs, C. Dubois, P. Sinnaeve, J. Dens, J. Vanhaecke, and F. Rademakers
Comparison of real-time tri-plane and conventional 2D dobutamine stress echocardiography for the assessment of coronary artery disease
Eur. Heart J., July 2, 2006; 27(14): 1719 - 1724.
[Abstract] [Full Text] [PDF]

Home page
 Eur J EchocardiogrHome page
P. Jeetley, L. Burden, and R. Senior
Stress echocardiography is superior to exercise ECG in the risk stratification of patients presenting with acute chest pain with negative Troponin
Eur J Echocardiogr, March 1, 2006; 7(2): 155 - 164.
[Abstract] [Full Text] [PDF]

Home page
 JAMAHome page
C. J. Swap and J. T. Nagurney
Value and Limitations of Chest Pain History in the Evaluation of Patients With Suspected Acute Coronary Syndromes
JAMA, November 23, 2005; 294(20): 2623 - 2629.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
J. Sanchis, V. Bodi, J. Nunez, V. Bertomeu-Gonzalez, C. Gomez, M. J. Bosch, L. Consuegra, X. Bosch, F. J. Chorro, and A. Llacer
New Risk Score for Patients With Acute Chest Pain, Non-ST-Segment Deviation, and Normal Troponin Concentrations: A Comparison With the TIMI Risk Score
J. Am. Coll. Cardiol., August 2, 2005; 46(3): 443 - 449.
[Abstract] [Full Text] [PDF]

Home page
 HeartHome page
J Sanchis, V Bodi, A Llacer, J Nunez, L Consuegra, M J Bosch, V Bertomeu, V Ruiz, and F J Chorro
Risk stratification of patients with acute chest pain and normal troponin concentrations
Heart, August 1, 2005; 91(8): 1013 - 1018.
[Abstract] [Full Text] [PDF]

Home page
 EuropaceHome page
D. G. Katritsis, I. Karabinos, A. Papadopoulos, P. Simeonidis, S. Korovesis, E. Giazitzoglou, E. Karvouni, and E. Voridis
Sustained ventricular tachycardia induced by dobutamine stress echocardiography: A prospective study
Europace, January 1, 2005; 7(5): 433 - 439.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
R. Bholasingh, J. H. Cornel, O. Kamp, J. P. van Straalen, G. T. Sanders, J. G. P. Tijssen, V. A. W. M. Umans, C. A. Visser, and R. J. de Winter
Prognostic value of predischarge dobutamine stress echocardiography in chest pain patients with a negative cardiac troponin T
J. Am. Coll. Cardiol., February 19, 2003; 41(4): 596 - 602.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (29)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Geleijnse, M.L
Right arrow Articles by Simoons, M.L
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Geleijnse, M.L
Right arrow Articles by Simoons, M.L
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?