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Usefulness of adenosine triphosphate-atropine stress echocardiography for detecting coronary artery stenosis
Y Miyazono1, A Kisanuki, K Toyonaga
1First Department of Internal Medicine, Faculty of Medicine, Kagoshima University, Kagoshima City, Japan.
Insights
Adenosine triphosphate (AT) stress echocardiography, especially with atropine, is a safe and effective tool for detecting coronary artery disease (CAD). This combined approach significantly improves diagnostic sensitivity compared to AT alone.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Pharmacology
Background:
- Few studies have investigated adenosine triphosphate (AT) stress echocardiography.
- AT stress testing may offer a better safety profile than adenosine stress testing.
- Combining AT with atropine may enhance the detection of coronary artery disease (CAD).
Purpose of the Study:
- To evaluate the utility of AT-atropine echocardiography for detecting CAD.
- To assess the safety and efficacy of this combined stress protocol.
Main Methods:
- 112 patients with suspected CAD underwent intravenous AT infusion (180 microg/kg/min for 14 minutes).
- Atropine (0.25 mg IV, max 1 mg) was administered after 8 minutes of AT infusion.
- Ischemic response defined as new/worsening wall motion abnormality; CAD detection assessed via echocardiograms.
Main Results:
- 62 patients had confirmed CAD.
- AT-atropine echocardiography demonstrated a sensitivity of 74% and specificity of 90% for CAD detection.
- Sensitivity and specificity were 78%/93% in patients without prior MI and 70%/86% in those with prior MI.
Conclusions:
- AT-atropine stress echocardiography is well-tolerated and safe.
- This method is useful for detecting CAD, with improved sensitivity over AT alone.
- The combined protocol offers a valuable diagnostic option for patients with suspected coronary artery disease.
Abstract:
There have been few studies on adenosine triphosphate (AT) stress echocardiography. The AT stress test may have fewer adverse effects than the adenosine stress test. The addition of atropine to AT echocardiography may enhance the sensitivity for detection of coronary artery disease (CAD). The purpose of this study was to determine the utility of AT-atropine echocardiography for detection of CAD. The group studied consisted of 112 patients with suspected CAD. Sixty-one patients did not have a history of prior myocardial infarction (group I) and 51 patients did (group II). AT was infused intravenously at 180 microg/kg/min for 14 minutes. Atropine (0.25 mg intravenously, repeated up to maximum total dose of 1 mg) was administered starting after 8 minutes of AT infusion. Ischemic response was defined as new or worsening wall motion abnormality occurring during the infusion. The sensitivity and specificity for detection of CAD were assessed using the representative echocardiograms during single AT infusion and AT-atropine infusion. Sixty-two patients had CAD. Fifty-eight patients (52%) developed minor side effects that resolved promptly. The rate-pressure product (10(3)/mm Hg beats/min) was significantly increased at 12 minutes of infusion (12.4+/-3.2) compared with that at baseline (9.1+/-2.3) and that at 6 minutes of infusion (9.4+/-2.1). The sensitivity for detection of CAD was 45% for AT echocardiography and 74% for AT-atropine echocardiography. The specificity was 94% for AT echocardiography and 90% for AT-atropine echocardiography. The sensitivity and specificity of AT-atropine echocardiography was 78% and 93%, respectively, in group I, and 70% and 86%, respectively, in group II. In conclusion, AT-atropine stress echocardiography seems to be well tolerated, safe, and useful for detection of CAD.