Tsutsui Jeane M, Osório Altamiro F F, Lario F Abio C, Fernandes Daniela R A, Sodre Gustavo, Andrade José L, Ramires José A F, Mathias Wilson
Laboratory of Echocardiography, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
Am J Cardiol. 2004 Dec 1;94(11):1367-72. doi: 10.1016/j.amjcard.2004.07.141.
Although dobutamine-atropine stress echocardiography (DASE) is an established method for evaluating patients who have coronary artery disease (CAD), it can increase test duration and a patient's exposure to large doses of dobutamine. New protocols, including the early injection of atropine during dobutamine stress echocardiography (EA-DSE), have been proposed to decrease test duration. This study compared the safety, efficacy, and accuracy of EA-DSE with those of DASE. We retrospectively evaluated 3,163 patients who underwent DASE and 1,664 patients who underwent EA-DSE over a period of 12 years. In EA-DSE, atropine at a dose </=2 mg was started with 20 microg/kg/min of dobutamine if heart rate was <100 beats/min. Diagnostic accuracy for detecting CAD (>50% stenosis) was assessed in patients who underwent quantitative angiography </=3 months of stress testing. The dobutamine dose used in EA-DSE was smaller than that used in DASE (31 +/- 6 vs 36 +/- 6 microg/kg/min, p <0.0001), although the atropine dose was larger (0.8 +/- 0.5 vs 0.5 +/- 0.25 mg, p <0.0001). EA-DSE resulted in a significantly shorter duration of dobutamine infusion (12.4 +/- 2.0 vs 14.6 +/- 2.5 minutes, p <0.0001), more diagnostic studies (88% vs 81%, p <0.0001), and a lower incidence of minor adverse effects than did DASE. The rate of major adverse effects was similar in the 2 protocols. Sensitivities, specificities, positive predictive values, negative predictive values, and accuracies for detecting CAD were 84%, 90%, 93%, 76%, and 86% for EA-DSE and 86%, 78%, 84%, 79%, and 82% for DASE, respectively (p = NS). Therefore, EA-DSE is a safe and effective alternative to DASE and had a similar accuracy for the detection of CAD.
尽管多巴酚丁胺 - 阿托品负荷超声心动图（DASE）是评估冠心病（CAD）患者的一种成熟方法，但它会延长检查时间，并增加患者接受大剂量多巴酚丁胺的暴露量。已提出新的方案，包括在多巴酚丁胺负荷超声心动图期间早期注射阿托品（EA - DSE），以缩短检查时间。本研究比较了EA - DSE与DASE的安全性、有效性和准确性。我们回顾性评估了12年间接受DASE的3163例患者和接受EA - DSE的1664例患者。在EA - DSE中，如果心率<100次/分钟，则在多巴酚丁胺剂量为20μg/（kg·min）时开始注射剂量≤2mg的阿托品。对在负荷试验后≤3个月接受定量血管造影的患者评估检测CAD（狭窄>50%）的诊断准确性。EA - DSE中使用的多巴酚丁胺剂量低于DASE（31±6 vs 36±6μg/（kg·min），p<0.0001），尽管阿托品剂量更大（0.8±0.5 vs 0.5±0.25mg，p<0.0001）。与DASE相比，EA - DSE导致多巴酚丁胺输注持续时间显著缩短（12.4±2.0 vs 14.6±2.5分钟，p<0.0001），诊断性检查更多（88% vs 81%，p<0.0001），且轻微不良反应发生率更低。两种方案中严重不良反应的发生率相似。EA - DSE检测CAD的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为84%、90%、93%、76%和86%，DASE分别为86%、78%、84%、79%和82%（p = 无显著性差异）。因此，EA - DSE是DASE的一种安全有效的替代方法，并且在检测CAD方面具有相似的准确性。
