| Effects of antianginal therapy with a calcium antagonist and nitrates on dobutamine-atropine stress echocardiography. Comparison with exercise electrocardiography. | |
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MedLine Citation:
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PMID: 9043840 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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 micrograms.kg-1.min-1)-atropine (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. |
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Authors:
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C Dodi; A Pingitore; R Sicari; G Bruno; A Cordovil; E Picano |
Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: European heart journal Volume: 18 ISSN: 0195-668X ISO Abbreviation: Eur. Heart J. Publication Date: 1997 Feb |
Date Detail:
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Created Date: 1997-05-05 Completed Date: 1997-05-05 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8006263 Medline TA: Eur Heart J Country: ENGLAND |
Other Details:
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Languages: eng Pagination: 242-7 Citation Subset: IM |
Affiliation:
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Guastalla Hospital, Reggio Emilia, Italy. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Atropine
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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* Electrocardiography Exercise Test / methods* Female Humans Infusions, Intravenous Isosorbide Dinitrate / administration & dosage, analogs & derivatives, therapeutic use Male 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 |
| Chemical | |
Reg. No./Substance:
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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 |
| Comments/Corrections | |
Comment In:
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Eur Heart J. 1997 Feb;18(2):180-1
[PMID:
9043829
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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