Sarullo Filippo Maria, Ventimiglia Corrado, Taormina Andrea, Azzarello Vincenzo, Felice Filippo, Martino Annamaria, Paterna Salvatore, Di Pasquale Pietro
Division of Cardiology, Buccheri La Ferla Fatebenefratelli Hospital, Via Salvatore Puglisi n.15, 90143 Palermo, Italy.
Int J Cardiovasc Imaging. 2007 Aug;23(4):511-8. doi: 10.1007/s10554-006-9169-5. Epub 2006 Nov 16.
Failure to reach 80% of maximal predicted heart rate (HR) during exercise may render a myocardial perfusion single photon emission computed tomography (SPECT) study non-diagnostic for ischemia detection. We sought to investigate the injection of atropine in patients who fail to achieve 80% of age-predicted HR during exercise performed for myocardial perfusion SPECT (MPS), defining its safety and efficacy to raise HR to adequate levels as well as its effect on MPS interpretation.
Between January 2002 and December 2004, we studied 3,150 consecutive patients (2,253 men and 897 women, mean age 55 +/- 6 years) who were referred to a single office-based nuclear cardiology laboratory for MPS using SPECT imaging. One milligram of atropine was administered to patients that were unable to continue because of fatigue before reaching minimal HR, without an ischemic response (group A, n = 397). The scintigraphic results for group A were compared with those of patients who spontaneously achieved target HR (group B, n = 2,753). In group A, mean HR before atropine injection was 119.5 +/- 13.6 beats per minute (bpm), and it increased up to 137.3 +/- 13.5 bpm after drug administration, with an incremental of 17.8 +/- 6.9 bpm (P < 0.0001). The mean percentage of age-related HR achieved in this group was 83.5 +/- 8.1%. In 302 of this patients (76.1%) more than 80% of their aged-related HR (86.9 +/- 5.1%) was attained. No major adverse effects occurred. When groups A and B were compared, baseline and peak HR, rate pressure product, and maximal metabolic equivalents achieved were higher in group B. There were no significant differences in the percentage of total positive perfusion studies between both groups: 210/397 patients (52.9%) in group A and 1,342/2,753 patients (48.7%) in group B (P = 0.39). Ischemia or ischemia plus scar was found in 112/397 patients (28.2%) in group A and in 923/2,753 patients (33.5%) of group B (P = 0.14).
Atropine added to exercise stress testing in patients who cannot achieve their 80% age-related HR is a safe, well-tolerated, and feasible method for MPS.
运动期间未能达到最大预测心率（HR）的80%可能会使心肌灌注单光子发射计算机断层扫描（SPECT）研究无法用于检测缺血。我们试图研究在进行心肌灌注SPECT（MPS）运动时未能达到年龄预测HR的80%的患者中注射阿托品的情况，确定其将HR提高到适当水平的安全性和有效性以及对MPS解读的影响。
在2002年1月至2004年12月期间，我们研究了3150例连续患者（2253例男性和897例女性，平均年龄55±6岁），这些患者被转诊至一家独立的核心脏病学门诊实验室进行使用SPECT成像的MPS检查。对于因疲劳在达到最低HR之前无法继续且无缺血反应的患者（A组，n = 397）给予1毫克阿托品。将A组的闪烁扫描结果与自发达到目标HR的患者（B组，n = 2753）的结果进行比较。在A组中，注射阿托品前的平均HR为每分钟119.5±13.6次心跳（bpm），给药后增加至137.3±13.5 bpm，增加了17.8±6.9 bpm（P < 0.0001）。该组达到的与年龄相关HR的平均百分比为83.5±8.1%。在这些患者中的302例（76.1%）中，达到了超过其年龄相关HR的80%（86.9±5.1%）。未发生重大不良反应。当比较A组和B组时，B组的基线和峰值HR、心率压力乘积以及达到的最大代谢当量更高。两组间总阳性灌注研究的百分比无显著差异：A组中210/397例患者（52.9%），B组中1342/2753例患者（48.7%）（P = 0.39）。A组中112/397例患者（28.2%）发现有缺血或缺血加瘢痕，B组中923/2753例患者（33.5%）发现有缺血或缺血加瘢痕（P = 0.14）。
对于无法达到其年龄相关HR的80%的患者在运动负荷试验中加用阿托品是一种用于MPS的安全、耐受性良好且可行的方法。
