Document Detail

Effects of antianginal therapy with a calcium antagonist and nitrates on dobutamine-atropine stress echocardiography. Comparison with exercise electrocardiography.
MedLine Citation:
PMID:  9043840     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Anti-ischaemic therapy with nitrates and/or calcium channel blockers profoundly affects the results of pharmacological stress echocardiography with coronary vasodilators but the influence on catecholamine stress testing remains unsettled. AIMS: The present study aimed to assess the effects of non-beta-blocker antianginal therapy on dobutamine (up to 40 (up to 1 mg) stress. echo-cardiography and to evaluate whether drug-induced changes in the dobutamine atropine stress echocardiography response may predict variations in exercise tolerance. METHODS: Twenty six patients with angiographically assessed coronary artery disease (seven patients with single-, 10 with double-, and nine with triple-vessel disease) performed a dobutamine atropine stress echocardiography and an exercise electrocardiography test in random order both off and on antianginal drugs (nitrates and calcium antagonists). In doubtamine-atropine stress echocardiography, we evaluated: dobutamine time (i.e. the time from initiation of the dobutamine infusion to obvious dyssynergy), wall motion score index (in a 16-segment model of the left ventricle, each segment ranging from 1 = normal, to 4 = dyskinetic), and rate-pressure product at peak stress. RESULTS: Dobutamine-atropine stress echocardiography positivity occurred in 26 out of 26 patients off and in 23 patients on therapy (100 vs 88%, P = ns). Atropine coadministration was needed to evoke echo positivity in no patient off and in five out of 26 on therapy (0 vs 19% P < 0.01). The achieved rate pressure product during dobutamine-atropine stress echocardiography was comparable on and off therapy (17 +/- 4 vs 19 +/- 5 x 10(3) mmHg x heart rate. min-1, P = ns). Therapy induced an increase in dobutamine time (on = 16 +/- 3 vs of = 13 +/- 3 min, P < 0.01) and a decrease in peak wall motion score index (on = 1.3 +/- 0.2 vs off = 1.5 +/- 0.3, P < 0.01). The therapy induced changes in exercise time during the exercise electrocardiography test were not significantly correlated to dobutamine-atropine stress echocardiography variations in either dobutamine time (r = 0.07, P = ns), or peak rate pressure product (r = 0.24, P = ns), or peak wall motion score index (r = 0.02, P = ns). CONCLUSIONS: (1) non-beta-blocker antianginal therapy only modestly reduces dobutamine-atropine stress echocardiography sensitivity, although atropine coadministration is more often required to reach stress echo positivity under therapy; (2) therapy reduces the severity of dobutamine atropine stress echocardiography ischaemia stratified in the time and space domain, but these changes are only poorly correlated to variations in exercise tolerance.
C Dodi; A Pingitore; R Sicari; G Bruno; A Cordovil; E Picano
Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  European heart journal     Volume:  18     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  1997 Feb 
Date Detail:
Created Date:  1997-05-05     Completed Date:  1997-05-05     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  242-7     Citation Subset:  IM    
Guastalla Hospital, Reggio Emilia, Italy.
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MeSH Terms
Atropine / administration & dosage,  diagnostic use*
Calcium Channel Blockers / administration & dosage,  therapeutic use*
Cardiotonic Agents / administration & dosage,  diagnostic use*
Coronary Disease / drug therapy,  physiopathology,  ultrasonography*
Diltiazem / administration & dosage,  therapeutic use
Dobutamine / administration & dosage,  diagnostic use*
Dose-Response Relationship, Drug
Echocardiography / drug effects*
Exercise Test / methods*
Infusions, Intravenous
Isosorbide Dinitrate / administration & dosage,  analogs & derivatives,  therapeutic use
Middle Aged
Nifedipine / administration & dosage,  therapeutic use
Nitrates / administration & dosage,  therapeutic use*
Parasympatholytics / administration & dosage,  diagnostic use*
Prospective Studies
Vasodilator Agents / administration & dosage,  therapeutic use
Reg. No./Substance:
0/Calcium Channel Blockers; 0/Cardiotonic Agents; 0/Nitrates; 0/Parasympatholytics; 0/Vasodilator Agents; 16051-77-7/isosorbide-5-mononitrate; 21829-25-4/Nifedipine; 34368-04-2/Dobutamine; 42399-41-7/Diltiazem; 51-55-8/Atropine; 87-33-2/Isosorbide Dinitrate
Comment In:
Eur Heart J. 1997 Feb;18(2):180-1   [PMID:  9043829 ]

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