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Safety of dobutamine-atropine stress myocardial perfusion scintigraphy
A Elhendy1, R Valkema, R T van Domburg
1Thoraxcenter and Department of Nuclear Medicine, University Hospital Rotterdam-Dijkzigt, Erasmus University, Rotterdam, The Netherlands.
Insights
Dobutamine stress testing is a feasible and safe method for evaluating coronary artery disease. Patients with more severe perfusion abnormalities face a higher risk of tachyarrhythmias during the test.
Area of Science:
- Cardiology
- Nuclear Cardiology
- Diagnostic Imaging
Background:
- Dobutamine stress testing is widely used for diagnosing coronary artery disease.
- The link between myocardial perfusion defects and test complications remains understudied.
Purpose of the Study:
- To evaluate the safety and feasibility of dobutamine-atropine stress myocardial perfusion SPECT.
- To identify predictors of complications during the test.
Main Methods:
- 1076 patients underwent dobutamine-atropine stress myocardial perfusion SPECT (using 201TI, 99mTc-MIBI, or tetrofosmin).
- Hemodynamic parameters, safety, and feasibility were assessed.
- Predictors of hypotension and arrhythmias were analyzed.
Main Results:
- The test was feasible in 94% of patients, with no deaths or infarctions.
- Hypotension occurred in 3.4%, predicted by higher baseline blood pressure, ischemic segments, and age.
- Supraventricular tachyarrhythmias (4.4%) and ventricular tachycardia (3.8%) were observed, predicted by infarction score and age/gender.
Conclusions:
- Dobutamine-atropine myocardial perfusion scintigraphy is a feasible and safe method for coronary artery disease evaluation.
- Fixed perfusion defects predict a higher risk of tachyarrhythmias during the test.
Unlabelled:
Dobutamine stress testing is increasingly used for the diagnosis and functional evaluation of coronary artery disease. However, the relationship between myocardial perfusion abnormalities and complications of the test has not been studied.
Methods:
We studied the hemodynamic profile, safety and feasibility of dobutamine (up to 40 microg/kg/min)-atropine (up to 1 mg) stress myocardial perfusion SPECT imaging (with 201TI, 99mTc-MIBI or tetrofosmin) in a consecutive series of 1076 patients (age = 59 +/- 11 yr, 50% with previous myocardial infarction) referred for evaluation of myocardial ischemia.
Results:
No infarction or death occurred during the test. The test was considered feasible (achievement of 85% of the target heart rate or an ischemic endpoint) in 1005 patients (94%). Hypotension (systolic blood pressure drop > or = 40 mm Hg) occurred in 37 patients (3.4%). Independent predictors were higher baseline systolic blood pressure (p < 0.0001), number of ischemic segments (p < 0.05) and age (p < 0.05). Supraventricular tachyarrhythmias occurred in 48 patients (4.4%). Independent predictors were fixed perfusion defect (infarction) score (p < 0.005) and age (p < 0.05). Ventricular tachycardia occurred in 41 patients (3.8%). Independent predictors were infarction score (p < 0.01) and male gender (p < 0.05). All arrhythmias terminated spontaneously or after metoprolol administration.
Conclusion:
Dobutamine-atropine myocardial perfusion scintigraphy is a feasible method for the evaluation of coronary artery disease with a safety profile and feasibility comparable to those reported for dobutamine stress echocardiography. Patients with more severe fixed perfusion abnormalities are at a higher risk of developing tachyarrhythmias during the test.