Safety of dobutamine-atropine stress echocardiography: A prospective experience of 4033 consecutive studies

Dobutamine-atropine stress echocardiography (DASE) is an established method and has been shown to be accurate for the detection of coronary artery dis ease. Still, there are few large clinical studies that analyze the safety o f DASE in general of the safety of performing it on an ambulatory basis. Mo st studies use a target heart rate as the primary end point regardless of w hether asymptomatic ischemia occurs. Such studies have shown a serious card iac event rate of approximately 0.3%. We prospectively studied 4033 consecu tive patients on an ambulatory basis and in the hospital with the use of DA SE from July 1991 to December 1998. All tests were performed by an experien ced physician, and all clinical and DASE data were stored in a large databa se organized at the beginning of the study. Dobutamine was infused in scala r doses of 5, 10, 20, 30, and 40 mu g/kg per minute in 3-minute stages. Dev elopment of a new wall motion abnormality, achievement of 85% of target hea rt, and end of the DASE infusion protocol were used as an end point. If 85% of the target heart rate was not achieved, atropine was infused up to 1 mg in the absence of myocardial ischemia, which was used in 1280 studies. The re were 3645 diagnostic tests, and 388 (10%) were found to be nondiagnostic . This result was due to poor image quality in 115 (3%), end of protocol in negative-submaximal examinations in 124 (3%), and limiting side effects in 149 (4%). Thirty-seven percent of the tests showed positive results for my ocardial ischemia. Major test-related cardiac complications occurred in 10 (0.25%) patients and included 1 ventricular fibrillation, 1 case of myocard ial infarction, and 8 cases of sustained ventricular tachycardia. Atropine poisoning was observed in 5 (0.12%) patients. No deaths occurred as a direc t or indirect consequence of DASE. We conclude that dobutamine-atropine str ess echocardiography is a reasonably safe method for detection of coronary artery disease in the hospital or in an ambulatory basis. The use of new wa ll motion abnormality as 1 of the end points may prevent further ischemia-r elated complications.