open access

Vol 68, No 4 (2010)
Original articles
Published online: 2010-04-23
Submitted: 2012-12-28
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Early atropine is safer than conventional atropine administration in the elderly undergoing dobutamine stress echocardiography

Zainab Abdel-Salam, Wail Nammas
Kardiol Pol 2010;68(4):428-434.

open access

Vol 68, No 4 (2010)
Original articles
Published online: 2010-04-23
Submitted: 2012-12-28

Abstract

Background: Early injection of atropine during dobutamine stress echocardiography has been demonstrated in retrospective analyses to reduce the duration and dose of dobutamine infusion, while preserving a similar diagnostic accuracy with a lower incidence of adverse effects.
Aim: In our prospective study, we sought to explore the safety of the early atropine-dobutamine stress echocardiography protocol compared to the conventional protocol in elderly patients.
Methods: We enrolled 100 consecutive elderly patients who had been referred to our echocardiography laboratory for evaluation of myocardial ischemia. Once eligible, patients were randomly assigned to undergo either the conventional protocol (Group 1, 50 patients) or early atropine protocol (Group 2, 50 patients) where atropine was started at dobutamine infusion rate of 20 μg/kg/min if the heart rate was < 100 beats/min, and at 30 μg/kg/min if the heart rate was < 120 beats/min, (max 2.0 mg). Test duration and total dobutamine dose were calculated.
Results: The mean age of the whole study cohort was 69.8 ± 2.8 years, 54 (54%) being males. Patients in Group 1 received a higher total dose of dobutamine (15.7 ± 0.8 vs 12.2 ± 1.5 mg) and had a longer test duration (14.3 ± 3.5 vs 11.5 ± 1.3 min) as compared to Group 2 (p < 0.01 for both). The two groups received a similar total dose of atropine (NS). Group 1 patients had a higher incidence of ventricular extra-systoles, non-sustained ventricular tachycardia, atrial fibrillation, and hypotension.
Conclusions: In elderly patients undergoing dobutamine stress echocardiography, adopting the early atropine protocol offers a shorter test duration and a lower dobutamine dose, with consequently fewer adverse effects.

Abstract

Background: Early injection of atropine during dobutamine stress echocardiography has been demonstrated in retrospective analyses to reduce the duration and dose of dobutamine infusion, while preserving a similar diagnostic accuracy with a lower incidence of adverse effects.
Aim: In our prospective study, we sought to explore the safety of the early atropine-dobutamine stress echocardiography protocol compared to the conventional protocol in elderly patients.
Methods: We enrolled 100 consecutive elderly patients who had been referred to our echocardiography laboratory for evaluation of myocardial ischemia. Once eligible, patients were randomly assigned to undergo either the conventional protocol (Group 1, 50 patients) or early atropine protocol (Group 2, 50 patients) where atropine was started at dobutamine infusion rate of 20 μg/kg/min if the heart rate was < 100 beats/min, and at 30 μg/kg/min if the heart rate was < 120 beats/min, (max 2.0 mg). Test duration and total dobutamine dose were calculated.
Results: The mean age of the whole study cohort was 69.8 ± 2.8 years, 54 (54%) being males. Patients in Group 1 received a higher total dose of dobutamine (15.7 ± 0.8 vs 12.2 ± 1.5 mg) and had a longer test duration (14.3 ± 3.5 vs 11.5 ± 1.3 min) as compared to Group 2 (p < 0.01 for both). The two groups received a similar total dose of atropine (NS). Group 1 patients had a higher incidence of ventricular extra-systoles, non-sustained ventricular tachycardia, atrial fibrillation, and hypotension.
Conclusions: In elderly patients undergoing dobutamine stress echocardiography, adopting the early atropine protocol offers a shorter test duration and a lower dobutamine dose, with consequently fewer adverse effects.
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Keywords

dobutamine stress echocardiography; atropine; safety; elderly

About this article
Title

Early atropine is safer than conventional atropine administration in the elderly undergoing dobutamine stress echocardiography

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 68, No 4 (2010)

Pages

428-434

Published online

2010-04-23

Bibliographic record

Kardiol Pol 2010;68(4):428-434.

Keywords

dobutamine stress echocardiography
atropine
safety
elderly

Authors

Zainab Abdel-Salam
Wail Nammas

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