SAFETY AND FEASIBILITY OF DOBUTAMINE-ATROPINE STRESS ECHOCARDIOGRAPHYFOR THE DIAGNOSIS OF CORONARY-ARTERY DISEASE IN DIABETIC-PATIENTS UNABLE TO PERFORM AN EXERCISE STRESS TEST

OBJECTIVE - Dobutamine stress testing is increasingly used for the dia gnosis and functional evaluation of coronary artery disease. However, little is known about the safety and feasibility of this stress modali ty in diabetic patients.RESEARCH DESIGN AND METHODS - We studied the i mpact of diabetes on hemodynamic profile and on the safety and feasibi lity of dobutamine (up to 40 mu g . kg(-1) . min(-1)) and atropine (up to 1 mg) stress echocardiography for the diagnosis of coronary artery disease in 1,446 consecutive patients (aged 60 +/- 12 years, 962 men) with limited exercise capacity and suspected myocardial ischemia. Of these, 184 patients were known to have IDDM or NIDDM. The test was con sidered feasible when 85% of the maximal heart rate and/or an ischemic end point (new or worsened wall motion abnormalities, ST segment depr ession, or angina) was achieved. RESULTS - No myocardial infarction or death occurred during the test. There was no significant difference b etween diabetic and nondiabetic patients with regard to heart rate inc rease during dobutamine stress echocardiography (58 +/- 25 vs. 61 +/- 24 beats/min),peak rate pressure product (18,400 +/- 3,135 vs. 18,048 +/- 4454), or the prevalence of hypotension (systolic blood pressure d rop of >40 mmHg) (7 vs. 5%), ventricular tachycardia (5.4 vs. 4.5%), a nd supraventricular tachycardia (3 vs. 4%) during the test. Dobutamine stress echocardiography was feasible in 92% of the diabetic patients and in 90% of the nondiabetic patients. Coronary angiography was perfo rmed in 55 diabetic and 240 nondiabetic patients. Sensitivity, specifi city and accuracy of dobutamine stress echocardiography for the diagno sis of coronary artery disease in diabetic patients were 81, 85, and 8 2%. Those in nondiabetic patients were 74, 87, and 77%, respectively ( NS). CONCLUSIONS - Dobutamine stress echocardiography is a feasible me thod for the diagnosis of coronary artery disease in patients with lim ited exercise capacity with a comparable safety, feasibility, and accu racy in diabetic and nondiabetic patients.