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

Area of Science:

• Cardiology
• Diagnostic Imaging
• Clinical Echocardiography

Background:

• Unstable angina was traditionally a contraindication for dobutamine-atropine stress echocardiography (DSE).
• The safety and prognostic utility of DSE in unstable angina (UA) patients remained largely unknown.
• This study aimed to evaluate DSE in UA patients.

Purpose of the Study:

• To assess the safety of dobutamine-atropine stress echocardiography in patients with unstable angina.
• To determine the prognostic value of dobutamine-atropine stress echocardiography in unstable angina.
• To investigate the role of DSE in risk stratification and management of UA.

Main Methods:

• 132 patients with unstable angina underwent dobutamine-atropine stress echocardiography on day 3 of hospitalization.
• The primary endpoints included unstable angina, myocardial infarction, or cardiac death within 1 year.
• Patients were monitored for cardiac events during follow-up.

Main Results:

• No major complications occurred during DSE, indicating its safety.
• A negative DSE for ischemia was associated with a 91% event-free survival at 1 year, versus 57% for positive DSE (P<0.0001).
• Left ventricular dysfunction, prior myocardial infarction, and positive DSE were independent predictors of cardiac events.

Conclusions:

• Dobutamine-atropine stress echocardiography is safe in unstable angina patients if performed at least 48 hours after symptom resolution.
• A negative DSE predicts a favorable prognosis in medically treated UA patients, supporting early discharge.
• DSE provides valuable prognostic information even with beta-blocker use and lower heart rates.