Feasibility and prognostic value of dobutamine-atropine stress echocardiography early in unstable angina

Background and Aim Because unstable angina has always been considered a con traindication for dobutamine-atropine stress echocardiography (DSE), the ro le of dobutamine-atropine stress echocardiography in unstable angina is unk nown. Our aim was to assess the safety and prognostic value of dobutamine-a tropine stress echocardiography in unstable angina. Methods One hundred and thirty-two patients were studied (mean age 64 +/- 1 2 years, 29 women). Dobutamine-atropine stress echocardiography was perform ed on the third day after hospital admission. End-points were unstable angi na, myocardial infarction or cardiac death at 1 year follow-up. Results No major complications occurred during dobutamine-atropine stress e chocardiography. Ninety-six (78%) patients were on beta-blocker therapy dur ing the test; mean maximum heart rate achieved was 106 +/- 23 beats.min(-1) . Nine of the 21 patients (43%) with a positive dobutamine-atropine stress echocardiography presented cardiac events during follow-up: two patients di ed, one had a myocardial infarction and six had recurrent class III-IV angi na. Among 80 patients with negative dobutamine-atropine stress echocardiogr aphy, one (1%) had myocardial infarction and six patients (7.5%) had recurr ent angina. Event-free survival after 1 year for patients with a negative d obutamine-atropine stress echocardiography for ischaemia was 91% compared t o 57% for those with a positive dobutamine-atropine stress echocardiography (P < 0.0001). Left ventricular dysfunction (P = 0.01), prior myocardial in farction (P = 0.03) and a positive dobutamine-atropine stress echocardiogra phy (P = 0.004) were independent predictors of cardiac events during follow -up. Conclusions Dobutamine-atropine stress echocardiography is safe in unstable angina if it is performed when patients remain asymptomatic for at least 4 8 h. A negative dobutamine-atropine stress echocardiogram for ischaemia pre dicts a good prognosis in medically treated patients with unstable angina a nd may allow their early discharge from hospital. Good prognostic informati on was obtained despite the use of beta-blockers and low heart rates during dobutamine-atropine stress echocardiography. (C) 2000 The European Society of Cardiology.