Tsutsui Jeane Mike, Falcão Sandra Nívea Reis Saraiva, Dourado Paulo Magno Martins, Lima Marta Fernandes, Alves Angele Azevedo, Guerra Vitor Coimbra, Ramires José Antônio Franchini, Mathias Wilson
Heart Institute (InCor), University of São Paulo Medical School, Avenida Dr. Enéas Carvalho de Aguiar 44, São Paulo, Brazil.
Echocardiography. 2007 Sep;24(8):843-50. doi: 10.1111/j.1540-8175.2007.00487.x.
The aim of this study was to determine the influence of gender on chronotropic and hemodynamic response during dobutamine stress echocardiography with early injection of atropine (EA-DSE).
From January 2000 to June 2003, we retrospectively evaluated patients who underwent EA-DSE for known or suspected coronary artery disease. We studied 494 patients, 243 men and 251 women, who were not under beta-blocker or calcium channel-blocker therapy (Group A) and 326 patients, 157 men and 169 women, using these medications (Group B). Differences on chronotropic and hemodynamic responses during EA-DSE were assessed by gender in the two groups. Predictors of need for higher doses of dobutamine were determined by multivariate analysis.
In Group A, higher proportion of women achieved test end points at the stage of 20 mcg/kg per minute. Dobutamine and atropine doses were lower in women than in men (29 +/- 5 versus 31 +/- 6 mcg/kg per minute; P = 0.001 and 0.61 +/- 0.32 versus 0.78 +/- 0.43 mg; P = 0.006). Cardiac chronotropism and systolic blood pressure response patterns differed by gender. In Group B, there was no difference in the proportion of patients who achieved test end points at each stage of dobutamine. The independent predictors of the need for higher doses of dobutamine in Group A were gender [Odds Ratio (OR) = 1.99, 95% Confidence Interval (CI) = 1.19-3.32; P = 0.008], age (OR = 0.91,CI = 0.89-0.93; P < 0.001), and baseline heart rate (OR = 0.95,CI = 0.93-0.98; P < 0.001). Independent predictors in the total population were age (OR = 0.92,CI = 0.90-0.94; P < 0.001), baseline heart rate (OR = 0.95,CI = 0.93-0.97; P < 0.001), and beta-blocker therapy (OR = 0.42,CI = 0.18-1.51; P = 0.04).
Gender has influence on heart rate and blood pressure response to the EA-DSE in patients without use of drugs with negative chronotropic effects.
本研究旨在确定性别对早期注射阿托品的多巴酚丁胺负荷超声心动图（EA-DSE）期间变时性和血流动力学反应的影响。
从2000年1月至2003年6月，我们回顾性评估了因已知或疑似冠状动脉疾病接受EA-DSE的患者。我们研究了494例患者，其中243例男性和251例女性，这些患者未接受β受体阻滞剂或钙通道阻滞剂治疗（A组），以及326例患者，其中157例男性和169例女性，正在使用这些药物（B组）。通过性别评估两组在EA-DSE期间变时性和血流动力学反应的差异。通过多变量分析确定需要更高剂量多巴酚丁胺的预测因素。
在A组中，更高比例的女性在每分钟20微克/千克阶段达到试验终点。女性的多巴酚丁胺和阿托品剂量低于男性（29±5与31±6微克/千克每分钟；P = 0.001，以及0.61±0.32与0.78±0.43毫克；P = 0.006）。心脏变时性和收缩压反应模式因性别而异。在B组中，在多巴酚丁胺各阶段达到试验终点的患者比例没有差异。A组中需要更高剂量多巴酚丁胺的独立预测因素是性别[比值比（OR）= 1.99，95%置信区间（CI）= 1.19 - 3.32；P = 0.008]、年龄（OR = 0.91，CI = 0.89 - 0.93；P < 0.001）和基线心率（OR = 0.95，CI = 0.93 - 0.98；P < 0.001）。总体人群中的独立预测因素是年龄（OR = 0.92，CI = 0.90 - 0.94；P < 0.001）、基线心率（OR = 0.95，CI = 0.93 - 0.97；P < 0.001）和β受体阻滞剂治疗（OR = 0.42，CI = 0.18 - 1.51；P = 0.04）。
在未使用具有负性变时作用药物的患者中，性别对EA-DSE的心率和血压反应有影响。
