Cohen A, Weber H, Chauvel C, Monin J L, Dib J C, Diebold B, Guéret P
Saint-Antoine University Hospital, Paris, France.
Am J Cardiol. 1997 Mar 15;79(6):713-6. doi: 10.1016/s0002-9149(96)00855-7.
Arbutamine is a new catecholamine designed for use as a pharmacologic stress agent. This study compared the sensitivity of arbutamine with symptom-limited exercise to induce echocardiographic signs of ischemia. Arbutamine was administered by a computerized closed-loop delivery system that controls the infusion rate of arbutamine toward a predefined rate of heart rate increase and maximum heart rate limit. Beta blockers were stopped > or = 48 hours before both tests. Stress was stopped for intolerable symptoms, or clinical, electrocardiographic or echocardiographic signs of ischemia (new or worsening wall motion abnormality), target heart rate (> or = 85% age predicted maximum heart rate), or plateau of heart rate response. Thirty-seven patients were entered into the study (35 arbutamine and exercise, 1 arbutamine only, 1 exercise only), of which 30 had angiographic evidence of coronary artery disease (> or = 50% lumen diameter narrowing). Rate-pressure product increased significantly in response to both stress modalities (p < 0.001) and was significantly greater with exercise (11,308 +/- 2,443) than with arbutamine (9,486 +/- 2,479, p < 0.001). The time to maximum heart rate was longer during arbutamine stress echocardiography than during exercise testing (17.3 +/- 9.4 versus 9.3 +/- 4.2 minutes, respectively, p < 0.001). There were more patients with interpretable echo data for arbutamine (82%) than for exercise (67%). Sensitivity for recognition of myocardial ischemia was 94% (95% confidence interval 70% to 100%) and 88% (95% confidence interval 62% to 98%), respectively. The most frequent adverse events during arbutamine (n = 36) were dyspnea (5.6%) and tremor (5.6%). Two arbutamine stress tests were discontinued due to arrhythmias: 1 patient had premature atrial and ventricular beats, and the other had premature atrial contractions and atrial fibrillation. Arrhythmias were well tolerated and resolved without sequelae. In conclusion, the sensitivity of arbutamine to induce echocardiographic signs of ischemia was similar to that of exercise despite a lower rate-pressure product. Arbutamine was well tolerated and provides a reliable alternative to exercise echocardiography.
阿巴胺是一种新型儿茶酚胺，设计用作药理学应激剂。本研究比较了阿巴胺与症状限制性运动诱发缺血性超声心动图征象的敏感性。阿巴胺通过计算机闭环给药系统给药，该系统将阿巴胺的输注速率控制在预定义的心率增加速率和最大心率限制范围内。在两项检查前>或 = 48小时停用β受体阻滞剂。因出现无法耐受的症状，或临床、心电图或超声心动图缺血征象（新出现或加重的室壁运动异常）、目标心率（>或 = 85%年龄预测最大心率）或心率反应平台而停止应激。37例患者进入研究（35例接受阿巴胺和运动检查，1例仅接受阿巴胺检查，1例仅接受运动检查），其中30例有冠状动脉造影证据（管腔直径狭窄>或 = 50%）。两种应激方式均可使心率 - 血压乘积显著增加（p < 0.001），且运动时（11,308 ± 2,443）显著高于阿巴胺检查时（9,486 ± 2,479，p < 0.001）。阿巴胺负荷超声心动图检查时达到最大心率的时间比运动试验时长（分别为17.3 ± 9.4分钟和9.3 ± 4.2分钟，p < 0.001）。阿巴胺检查时有可解释超声数据的患者（82%）多于运动检查者（67%）。识别心肌缺血的敏感性分别为94%（95%置信区间70%至100%）和88%（95%置信区间62%至98%）。阿巴胺检查期间（n = 36）最常见的不良事件为呼吸困难（5.6%）和震颤（5.6%）。两项阿巴胺负荷试验因心律失常而中断：1例患者出现房性和室性早搏，另1例出现房性早搏和房颤。心律失常耐受性良好，且无后遗症而缓解。总之，尽管心率 - 血压乘积较低，但阿巴胺诱发缺血性超声心动图征象的敏感性与运动相似。阿巴胺耐受性良好，为运动负荷超声心动图提供了可靠的替代方法。
