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Dobutamine-atropine stress echocardiography in elderly patients unable to perform an exercise test. Hemodynamic
D Poldermans1, P M Fioretti, E Boersma
1Department of Vascular Surgery, University Hospital Rotterdam-Dijkzigt, The Netherlands.
Insights
Dobutamine-atropine stress echocardiography is a safe and feasible cardiac stress test for elderly patients. This test provides valuable prognostic information for perioperative and late cardiac risk assessment.
Area of Science:
- Cardiology
- Geriatric Medicine
- Diagnostic Imaging
Background:
- Elderly patients often present with atypical symptoms, complicating diagnosis of coronary artery disease.
- Assessing cardiac risk in older adults is crucial for preoperative planning and management.
Purpose of the Study:
- To evaluate the hemodynamic effects, safety, and prognostic utility of dobutamine-atropine stress echocardiography (DASE) in patients aged 70 years and older.
- To determine the correlation between stress-induced myocardial ischemia and adverse cardiac events in this population.
Main Methods:
- An observational study was conducted at a university hospital.
- 179 patients (mean age 75 years) underwent clinical evaluation and DASE.
- New wall motion abnormalities were assessed as a marker of myocardial ischemia.
Main Results:
- The test was successfully completed in 92% of patients, with a 7% rate of side effects.
- New wall motion abnormalities, indicative of ischemia, were observed in 28% of tests.
- Perioperative and late cardiac events were significantly correlated with stress-induced wall motion abnormalities.
Conclusions:
- Dobutamine-atropine stress echocardiography is a safe and feasible diagnostic tool for elderly patients.
- DASE provides significant prognostic information regarding perioperative and long-term cardiac risk.
- The test demonstrates a low rate of adverse events in the geriatric population.
Objective:
To establish the hemodynamic effects, safety, and prognostic value of dobutamine-atropine stress echocardiography in patients 70 years of age or older.
Design And Setting:
Observational study at a university hospital.
Patients:
One hundred seventy-nine patients (mean age, 75 years; range, 70 to 90 years) referred for chest pain (n = 73) or preoperative risk assessment for major vascular noncardiac surgery (n = 106).
Measurements:
All patients underwent clinical evaluation and dobutamine-atropine stress test.
Results:
One hundred seventy-nine stress tests were performed. Test end points were the target heart rate (85% of theoretical maximum heart rate), reached in 165 tests (92%); inadequate echo images, two tests (1%); and side effects, 12 tests (7%). Side effects that caused a premature end of the test were severe chest pain (n = 5 [2.8%]), electrocardiographic changes (n = 1 [0.6%]), hypotension (n = 2 [1.1%]), chills (n = 2 [1.1%]), and cardiac arrhythmias (paroxysmal atrial fibrillation) (n = 2 [1.1%]). New wall motion abnormalities as a marker of myocardial ischemia occurred in 50 tests (28%). No death or myocardial infarction occurred during the test. Perioperative events occurred in 12 patients (four cardiac deaths, three myocardial infarctions, and five episodes of unstable angina). During 16 +/- 6 months (mean +/- SD) of follow-up of 166 patients, 22 cardiac events occurred (eight cardiac deaths, four myocardial infarctions, and 10 episodes of unstable angina pectoris). By multivariate regression analysis, only perioperative cardiac events (odds ratio, 51; 95% confidence interval, 5.8 to 454) and late cardiac events (odds ratio, 5.2; 95% confidence interval, 2.0 to 14) were correlated with new wall motion abnormalities during stress.
Conclusion:
Dobutamine-atropine stress echocardiography is a feasible and safe test for assessing elderly patients with suspected and/or proven coronary artery disease, providing useful prognostic information for perioperative and late cardiac risk with relatively few side effects.