Safety and feasibility of atropine added to submaximal exercise stress testing with Tl-201 SPECT for the diagnosis of myocardial ischemia
- 46 Downloads
We aimed to assess whether atropine administration is safe and feasible in patients unable to reach the minimal heart rate (HR) required (80% of age-predicted HR) in myocardial scintigraphic studies after exercise stress testing (EST).
Methods and Results
We studied 108 patients who underwent myocardial perfusion scintigraphy after EST; 0.5 mg of atropine was administered to those showing signs of fatigue before reaching minimal HR (group A, n = 44). The scintigraphic results for group A were compared with those of patients who spontaneously achieved minimal HR (group B, n = 64). Coronary angiographic results, if available, and clinical follow-up were also compared. In group A, atropine increased HR by 13.7 ± 7.4 beats/min. The percentage of maximal age-related HR achieved was 83.3% ± 7.5%; 74% achieved minimal HR. No major adverse effects occurred. When groups A and B were compared, baseline and peak HR, rate pressure product, and maximal metabolic equivalents achieved were higher in group B. There were no differences in number of perfusion studies positive for ischemia (group A, 26/44, and group B, 30/64; P = .2), coronary lesions, or clinical follow-up.
Atropine added to EST in patients who cannot achieve their 80% age-related HR is a safe and potentially useful method for myocardial perfusion studies.(J Nucl Cardiol 2002;9:581-6.)
Key WordsAtropine submaximal exercise testing scintigraphy myocardial ischemia
Unable to display preview. Download preview PDF.
- 4.Gibbons RJ, Balady GJ, Beasley JW, Bricker JT, Duvernoy WFC, Froelicher VF, et al. ACC/AHA guidelines for exercise testing: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). J Am Coll Cardiol 1997;30:260–315.PubMedCrossRefGoogle Scholar
- 5.Santana Boado C, Candell Riera J, Castell Conesa J, García-Burillo A, Olona M, Palet J, et al. Diagnosis of coronary disease by means of stress gamma-tomography with 99m-technetium-isonitriles [in Spanish]. Med Clin (Barc) 1995; 105:201–4.Google Scholar
- 10.Ellestad MH. Cardiovascular response to exercise. In: Stress testing. Principles and practice. Philadelphia: F. A. Davis; 1986.Google Scholar
- 14.O’Leary DS, Rossi NF, Churchill PC. Substantial cardiac parasympathetic activity exists during heavy dynamic exercise in dogs. Am J Physiol 1997;273:2135–40.Google Scholar
- 17.Poldermans D, Rambaldi R, Bax JJ, Cornel JH, Thomson IR, Valkema R, et al. Safety and utility of atropine addition during dobutamine stress echocardiography for the assessment of viable myocardium in patients with severe left ventricular dysfunction. Eur Heart J 1998;19:1712–8.PubMedCrossRefGoogle Scholar