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Addition of atropine to submaximal exercise stress testing in patients evaluated for suspected ischaemia with SPECT imaging: a randomized, placebo-controlled trial

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the effects of the addition of atropine to exercise testing in patients who failed to achieve their target heart rate (HR) during stress myocardial perfusion imaging with single-photon emission computed tomography (SPECT).

Methods

The study was a prospective, randomized, placebo-controlled design. Patients with suspected or known coronary artery disease who failed to achieve a target HR (≥85% of maximal predicted HR) during exercise SPECT imaging were randomized to receive intravenous atropine (n = 100) or placebo (n = 101).

Results

The two groups of patients did not differ with respect to demographic or clinical characteristics. A higher proportion of patients in the atropine group achieved the target HR compared to the placebo group (60% versus 3%, p < 0.0001). SPECT imaging was abnormal in a higher proportion of patients in the atropine group as compared to the placebo group (57% versus 42%, p < 0.05). Stress-induced myocardial ischaemia was present in more patients in the atropine group as compared to placebo (47% versus 29%, p < 0.01). In both groups of patients, no major side effects occurred.

Conclusion

The addition of atropine at the end of exercise testing is more effective than placebo in raising HR to adequate levels, without additional risks of complications. The use of atropine in patients who initially failed to achieve their maximal predicted HR is associated with a higher probability of achieving a diagnostic myocardial perfusion study.

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Authors and Affiliations

  1. Department of Cardiology and Heart Surgery, San Giuseppe Moscati Hospital, Avellino, Italy

    Fiore Manganelli, Rosario Sauro, Emilio Di Lorenzo & Giuseppe Rosato

  2. Nuclear Medicine Unit, San Giuseppe Moscati Hospital, Avellino, Italy

    Marco Spadafora, Paola Varrella & Giuseppina Peluso

  3. Institute of Diagnostic and Nuclear Development (SDN), Naples, Italy

    Stefania Daniele & Alberto Cuocolo

  4. Department of Biomorphological and Functional Sciences, University Federico II, Naples, Italy

    Alberto Cuocolo

  5. Institute of Biostructures and Bioimages, National Council of Research, Naples, Italy

    Alberto Cuocolo

Authors
  1. Fiore Manganelli
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  2. Marco Spadafora
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  3. Paola Varrella
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  4. Giuseppina Peluso
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  5. Rosario Sauro
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  6. Emilio Di Lorenzo
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  7. Giuseppe Rosato
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  8. Stefania Daniele
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  9. Alberto Cuocolo
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Corresponding author

Correspondence to Alberto Cuocolo.

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Manganelli, F., Spadafora, M., Varrella, P. et al. Addition of atropine to submaximal exercise stress testing in patients evaluated for suspected ischaemia with SPECT imaging: a randomized, placebo-controlled trial. Eur J Nucl Med Mol Imaging 38, 245–251 (2011). https://doi.org/10.1007/s00259-010-1641-8

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  • DOI: https://doi.org/10.1007/s00259-010-1641-8

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