Early atropine-dobutamine echocardiography in diabetic patients

We sought to explore the efficacy and safety of the early atropine-dobutamine stress echocardiography (EA-DSE) protocol in comparison with the conventional atropine-dobutamine stress echocardiography (CA-DSE) protocol, in diabetic patients undergoing dobutamine stress echocardiography (DSE) for suspected coronary artery disease (CAD).

We enrolled 100 consecutive diabetic patients referred to our stress echocardiography labs for suspected CAD. Patients were randomly assigned to undergo either of the following two DSE protocols: CA-DSE (group 1; 50 patients) or EA-DSE (group 2; 50 patients) where atropine was started at a dobutamine infusion rate of 20 microg/kg/min, up to a maximum dose of 2.0 mg. Patients were monitored for adverse drug reactions. Test duration was calculated. All patients underwent coronary angiography. The mean age of the whole study population was 54.9 +/- 2.8 y, 56 (56%) being males. Patients in group 1 had a longer test duration (29.7 +/- 3.4 versus 14.7 +/- 1.3 minutes, respectively, P < 0.05). At peak stress, group 1 had a significantly lower heart rate, significantly higher systolic and diastolic blood pressure, and rate-pressure product (P < 0.05 for all). Group 1 patients had a higher incidence of arrhythmias, exaggerated blood pressure response, and hypotension as compared with group 2. The EA-DSE protocol had a similar diagnostic accuracy in comparison with the CA-DSE protocol (90% versus 92% respectively).

In diabetic patients with suspected CAD undergoing DSE, adopting the EA-DSE protocol offers shorter test duration, fewer adverse effects, and a diagnostic accuracy similar to that of the CA-DSE.