REPRODUCIBILITY OF THE DOBUTAMINE-ATROPINE ECHOCARDIOGRAPHY STRESS TEST

To assess the reproducibility of dobutamine-atropine echocardiography testing, two studies (1 to 20 days apart [mean 3.3 days]) were performed in 23 patients with stable effort angina pectoris or chest pain. During the study, 20 (87%) patients were receiving beta blockers alone or combined with nitrates or calcium antagonists. Dobutamine was infused at doses of 10 mug/kg per minute every 3 minutes up to a maximum of 40 mug/kg per minute and this maximal dose was continued for 6 minutes. In patients not achieving 85% predicted maximal heart rate or myocardial ischemia, atropine (025-1 mg) was added and dobutamine continued for another 3 minutes, until either an adequate heart rate was achieved or the test was considered positive. During dobutamine infusion, electrocardiographic, echocardiographic, and blood pressure monitoring were obtained in each patient. Side effects including tremor, nausea, palpitation, dizziness, headache, and nonsustained ventricular tachycardia occurred in three patients. The same symptoms, but no ventricular tachycardia, developed during the same stage of the second test. Angina pectoris (eight patients), electrocardiographic changes (six patients), and ischemic wall-motion abnormalities (six patients) were observed at the same stage of the two tests. The mean values of heart rate, blood pressure, and rate-pressure product were comparable for each stage in duplicate tests. Our data show that pharmacological stress echocardiography using dobutamine-atropine has good reproducibility and provides a useful tool for assessing disease progression and the effects of therapeutic interventions in patients with coronary artery disease.