DOBUTAMINE-ATROPINE STRESS ECHOCARDIOGRAPHY IN ELDERLY PATIENTS UNABLE TO PERFORM AN EXERCISE TEST - HEMODYNAMIC CHARACTERISTICS, SAFETY, AND PROGNOSTIC VALUE

Objective: To establish the hemodynamic effects, safety, and prognosti c value of dobutamine-atropine stress echocardiography in patients 70 years of age or older. Design and Setting: Observational study at a un iversity hospital. Patients: One hundred seventy-nine patients (mean a ge, 75 years; range, 70 to 90 years) referred for chest pain (n=73) or preoperative risk assessment for major vascular noncardiac surgery (n =106). Measurements: All patients underwent clinical evaluation and do butamine-atropine stress test. Results: One hundred seventy-nine stres s tests were performed. Test end points were the target heart rate (85 % of theoretical maximum heart rate), reached in 165 tests (92%); inad equate echo images, two tests (1%); and side effects, 12 tests (7%). S ide effects that caused a premature end of the test were severe chest pain (n=5 [2.8%]), electrocardiographic changes (n=1 [0.6%]),hypotensi on (n=2 [1.1%]), chills (n=2 [1.1%]), and cardiac arrhythmias (paroxys mal atrial fibrillation) (n=2 [1.1%]). New wall motion abnormalities a s a marker of myocardial ischemia occurred in 50 tests (28%). No death or myocardial infarction occurred during the test. Perioperative even ts occurred in 12 patients (four cardiac deaths, three myocardial infa rctions, and five episodes of unstable angina). During 16 +/- 6 months (mean +/- SD) of follow-up of 166 patients, 22 cardiac events occurre d (eight cardiac deaths, four myocardial infarctions, and 10 episodes of unstable angina pectoris). By multivariate regression analysis, onl y perioperative cardiac events (odds ratio, 51; 95% confidence interva l, 5.8 to 454) and late cardiac events (odds ratio, 5.2; 95% confidenc e interval, 2.0 to 14) were correlated with new wall motion abnormalit ies during stress. Conclusion: Dobutamine-atropine stress echocardiogr aphy is a feasible and safe test for assessing elderly patients with s uspected and/or proven coronary artery disease, providing useful progn ostic information for perioperative and late cardiac risk with relativ ely few side effects.