Dobutamine – ABC CARDIOL

ABCHF

Viewpoint

The Heart Transplant Prioritization System in Brazil: Challenges and Perspectives on the Use of Home Inotropes

Helena Garcia Betinardi Bernardi et al. Edimar Alcides Bocchi

Introduction

Despite advances in the treatment of heart failure with reduced ejection fraction (HFrEF), the disease still represents a significant clinical challenge, especially in advanced stages. It is estimated that up to 13% of patients do not respond to conventional therapies, progressing to severe forms of the syndrome, which are associated with high morbidity and mortality.^,

Globally, about 64 million people live with HF, and in Brazil, 941,576 hospitalizations due to HF were recorded between 2019 and 2023, with a progressive increase during this period. In 2023, the incidence was 101.83 cases per 100,000 inhabitants. These numbers reflect not only the magnitude of the problem but also the burden it imposes on the healthcare system.

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ABCHF

Case Report

Implementation of Home Use of Continuous Intravenous Inotrope as Palliative Therapy for a Patient with Advanced Heart Failure within the Brazilian Unified Health System: a Case Report

Ana Paula Chedid Mendes et al. Rita Zambonato Laura C. T. Hastenteufel Letícia Orlandin … Nadine Clausell Livia Adams Goldraich

Introduction

Contemporary evidence-based treatment has modified the natural history of heart failure (HF). Nevertheless, with the current aging of the population with HF and the elevated number of comorbidities, there is a large proportion of individuals who are ineligible for advanced therapies and who could potentially benefit from palliative care. Accordingly, strategies for relieving symptoms and improving quality of life are being prioritized over interventions that aim for medium- and long-term outcomes. For a subgroup of patients with advanced HF receiving palliative care, home therapy with continuous inotropes may be considered and integrated into general palliative care.

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ABCIC

Case Report

Coronary Flow Velocity Reserve and Myocardial Contractility Under Stress in the Post-Infarction Ischemic Memory Dilemma

Marilia Esther Benevides de Abreu et al. Tereza Cristina Diógenes Pinheiro Antônio Augusto Lima Guimarães José Sebastião de Abreu

Introduction

After acute myocardial infarction (AMI), some cases progress with deep T wave inversions on electrocardiogram (ECG). This electrocardiographic abnormality can continue for a prolonged period, even if a coronary intervention within a short time of AMI progression results in successful myocardial reperfusion. However, these deep T wave inversions can raise management questions when the patient is already being followed up in an outpatient clinic, particularly in the absence of relevant symptoms to support the resurgence of an ischemic process. In this context, a safe noninvasive assessment such as dobutamine stress echocardiography (DSE) associated with the analysis of coronary flow velocity reserve (CFVR) may be an option for this dilemma between myocardial ischemia and the possible post-infarction ischemic memory.^–

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ABCIC

Original Article

Analyzing the Safety and Predictors of Arrhythmias during Dobutamine-Atropine Stress Echocardiography in a Non-Hospital Setting

Daniela do Carmo Rassi et al. Rogério Gomes Furtado Fabio de Paula Turco Luciano Henrique Melato … Ana Caroline Reinaldo de Oliveira Colandy Nunes Dourado Luiz Rassi Jr

Abstract

Background

Dobutamine-atropine stress echocardiography (DASE) is an accessible and important test, especially in patients under investigation for coronary artery disease. However, it is necessary to evaluate its safety, as it is used in patients with increasingly complex and serious conditions and in seniors.

Objective

To confirm the safety of DASE and evaluate the predictors of arrhythmias in a non-hospital setting.

Methods

DASE was performed to evaluate ischemia using the standard protocol of dobutamine infusion of 5 to 40 mcg/kg/min associated with atropine.

Results

From September to November 2010, 227 patients were evaluated prospectively. The mean age was 60.7 +/- 12.5 years old and 60.8% were females. Mean ejection fraction was 67.9 +/- 9. Among the adverse events, 12 patients presented hypertensive response, 466 had arrhythmia, 58 had headaches and 57 had precordial pain. No patient had acute myocardial infarction, ventricular fibrillation, cardiac rupture, asystole or death. As for the onset of significant arrhythmia, three patients had atrial fibrillation, 16 had sustained supraventricular tachycardia, 19 had non-sustained ventricular tachycardia and 2 had sustained ventricular tachycardia. In these patients, age (OR = 1.0559, p = 0.0002) and segmental contractility index at rest (SCIr) > 1 (OR 2.5039, p = 0.0354) were independent predictors for the onset significant arrhythmia during the test.

Conclusion

DASE was proven safe in this group of patients in a non-hospital setting. Age and SCIr > 1 were independent predictors for the onset of significant arrhythmia during the test. (Arq Bras Cardiol: Imagem cardiovasc. 2018;31(3):168-174)

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ABCIC

Original Article

Analysis of the Safety and Feasibility of Dobutamine Stress Echocardiography in Ten Thousand and Six Tests of a General Population

José Sebastião de Abreu et al. Tereza Cristina Diógenes Pinheiro Marília Esther Benevides de Abreu Ana Gardenia Liberato Ponte Farias Marcia Maria Carneiro

Abstract

Background

Adverse effects and inconclusive results may occur on dobutamine stress echocardiography.

Objective

To assess the safety and feasibility of dobutamine stress echocardiography in a large general population.

Methods

A total of 10,006 dobutamine stress echocardiographies were performed between July 1996 and September 2007. Dobutamine was administered in four stages (10, 20, 30, and 40 μcg·kg^-1·min^-1) to research myocardial ischemia starting with 5 μcg·kg^-1·min^-1 to analyze myocardial viability. Atropine was started according to the protocols used in the period. Clinical, hemodynamic, and adverse effect data associated with dobutamine stress echocardiography findings were verified.

Results

Typical angina (8.9%), hypertensive peak (1.7%), isolated ventricular ectopias (31%), supraventricular tachyarrhythmia (1.89%), atrial fibrillation (0.76%), and non-sustained ventricular tachycardia (0.6%) occurred during dobutamine stress echocardiography. The adverse effects occurred more frequently in patients with positive dobutamine stress echocardiography findings for ischemia than in those with negative findings. Paradoxical sinus deceleration (0.16%) did not occur in cases of positive dobutamine stress echocardiography findings. Three severe complications occurred in cases that tested positive for ischemia on dobutamine stress echocardiography: two (0.02%) of ventricular fibrillation and one of acute coronary syndrome (0.01%). There were no cases of sustained ventricular tachycardia, cardiac rupture, asystole, or death. Compared to those with complete tests, patients with inconclusive results used less atropine (81.5% versus 49.9%, p < 0.001) and more beta-blockers (4.7% versus 19%, p < 0.001) and more commonly presented with a hypertensive peak (1.1% versus 14.2%, p = 0.0001) or non-sustained ventricular tachycardia (0.5% versus 2.2%, p < 0.001).

Conclusion

When properly performed, dobutamine stress echocardiography is safe and has high feasibility.

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Brief Communication

Continuous Intravenous Inotropes in Ward Units: Expanding Therapy Outside Intensive Care using a Safety-Oriented Protocol

Laura Caroline Tavares Hastenteufel et al. Nadine Clausell Jeruza Lavanholi Neyeloff Fernanda Bandeira Domingues … Larissa Gussatschenko Caballero Eneida Rejane Rabelo da Silva Lívia Adams Goldraich

Abstract

Selected clinically stable patients with heart failure (HF) who require prolonged intravenous inotropic therapy may benefit from its continuity out of the intensive care unit (ICU). We aimed to report on the initial experience and safety of a structured protocol for inotropic therapy in non-intensive care units in 28 consecutive patients hospitalized with HF that were discharged from ICU. The utilization of low to moderate inotropic doses oriented by a safety-focused process of care may reconfigure their role as a transition therapy while awaiting definitive advanced therapies and enable early ICU discharge.

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Review Article

Is there evidence favoring the use of beta-blockers and dobutamine in acute heart failure?

Luiz Carlos Santana Passos et al. Andréa Cristina Costa Barbosa Márcio Galvão Oliveira Edval Gomes Santos Jr

Several studies have reported the benefits of beta-blockers (BB) for patients presenting with systolic heart failure. however, many patients hospitalized as a result of acute heart failure are already using BB and require dobutamine for arterial hypotension and low cardiac output. Therefore, a decision must be made regarding whether BB should be maintained or even started in such cases. The aim of this study was to establish whether there is evidence supporting the safety andyeffectiveness of BB together with dobutamine for patients presenting with acute decompensated heart failure (ADHF). We conducted a search of the English-language literature in the databases MEDLINE, ISI Web of Science, Virtual Health Library, Cochrane Library and the CAPES Portal of Scientific Journals to identify related studies. Additional literature was obtained through the review of relevant references in the identified articles. The expected outcomes included information on the prognosis (in-hospital and on follow-up mortality, number of days of hospitalization and readmission),yeffectiveness and safety (worsening of symptoms, shock, intolerance) of the concomitant use of these drugs in hospitalized patients with ADHF and low cardiac output. This review included nine studies. however, no randomized clinical trials on this subject were found. Most studies include a low number of patients, and no studies addressing the safety of the concomitant use of these drugs were found. The resulting data suggest that a careful literature review did not supply evidence for the systematic use of BB in patients with low cardiac output syndrome who require dobutamine for inotropic support.

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Artigo Original

Acute effects of levosimendan and dobutamine on QRS duration in patients with heart failure

Osman Can Yontar et al. Mehmet Birhan Yilmaz Kenan Yalta Alim Erdem Izzet Tandogan

BACKGROUND: Levosimendan is a novel inotropic agent that enhances cardiac contractility without increasing cellular calcium intake, so that it is not supposed to cause intracellular calcium overload and related arrhythmias. In patients with heart failure, prolonged QRS duration is associated with increased risk of mortality and sudden cardiac death. Structural changes in the left ventricle may lead to asynchronous contraction, causing conduction delay and a prolonged QRS on the surface electrocardiogram. OBJECTIVE: We aimed to compare the acute effects of levosimendan and dobutamine on QRS duration in patients with severe heart failure and sinus rhythm. METHODS: Sixty consecutive patients with ischemic heart failure were enrolled for the study and randomized into two groups for levosimendan (n=37) or dobutamine (n=23) infusions. 67.2 % were male; mean age was 66.4±9.2 years for all patients. Baseline QRS durations in levosimendan and dobutamine groups were, 120.44 ± 23.82 ms vs 116.59 ± 13.80 ms respectively. Baseline ejection fractions were both depressed (23.15 ± 8.3% vs 24.56 ± 7.5%). RESULTS: In the levosimendan group, QRS duration shortened from baseline value to 116.47 ± 24.56 msec (p=0.006), whereas dobutamine group showed no significant change (p=0.605). Both drugs caused an increase in ejection fraction, but only the levosimendan group showed significance (27.95 ± 8.9% p=0.003 vs 26.67 ± 7.6%, p=0.315). CONCLUSION: We suggest that the administration of levosimendan, not dobutamine, shortens QRS duration on the surface ECG, possibly by means of providing collective contraction in the left ventricle muscle fibers. The molecular basis of this effect remains to be clarified.

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Artigo Original

Is it necessary to suspend betablockers in decompensated heart failure with low output?

Marcelo Villaça Lima et al. Juliano Novaes Cardoso Marcelo Eidi Ochiai Katiuska Massucatti Grativvol … Petherson Susano Grativvol Euler C. O. Brancalhão Robinson Tadeu Munhoz Paulo Cesar Morgado Airton R. Scipioni Antonio Carlos Pereira Barretto

BACKGROUND: There is evidence that the suspension of betablockers (BB) in decompensated heart failure may increase mortality. Dobutamine (dobuta) is the most commonly used inotrope in decompensation, however, BB and dobuta act with the same receptor with antagonist actions, and concurrent use of both drugs could hinder compensation. OBJECTIVE: To evaluate whether the maintenance of BB associated with dobuta difficults cardiac compensation. METHODS: We studied 44 patients with LVEF < 45% and the need for inotropics. Divided into three groups according to the use of BB. Group A (n=8): those who were not using BB at baseline; Group B (n=25): those who used BB, but was suspended to start dobuta; Group C (n = 11): those who used BB concomitant to dobuta. To compare groups, we used the Student t, Fisher exact and chi-square tests. Considered significant if p < 0.05. RESULTS: Mean LVEF 23.8 ± 6.6%. The average use of dobuta use was similar in all groups (p = 0.35), and concomitant use of dobutamine with BB did not increase the length of stay (BB 20.36 ± 11.04 days vs without BB 28.37 ± 12.76 days, p = NS). In the high dose, BB was higher in patients whose medication was not suspended (35.8 ± 16.8 mg/day vs 23.0 ± 16.7 mg/day, p = 0.004). CONCLUSION: Maintaining BB associated with dobutamine did not increase the length of hospitalization and was not associated with the worst outcome. Patients who did not suspend BB were discharged with higher doses of the drug.

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Case Report

Dobutamine stress echocardiography-induced broken heart syndrome (Takotsubo Syndrome)

Francisco Juarez Cruz de Vasconcelos Filho et al. Cezario Antonio Martins Gomes Oscar Aires de Queiroz José Erirtonio Façanha Barreto

We report a case of dobutamine stress echocardiography-induced Takotsubo syndrome in a 76-year-old hypertensive patient with clinical complaints of chest pain in an elective visit to the cardiologist. Dobutamine-stress-echocardiography was requested to rule out chest pain of coronary origin. During the test, at peak exercise, echocardiogram showed apical akinesia and electrocardiogram showed ST-segment elevation in D1, AVL, and V2. The patient was hospitalized and underwent coronary angiography, which showed normal coronary arteries and left ventricular apical ballooning. During follow-up, the patient’s condition remained stable, with regression of the manifestations 21 days after the initial presentation.

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Artigo Original

Dobutamine-stress echocardiography in asymptomatic patients with aortic regurgitation

Marcia M. Barbosa et al. Claudia M. V. Freire Lúcia M. A. Fenelon William A. M. Esteves … Gilmar Reis Maria do Carmo P. Nunes

BACKGROUND: Decreased contractile reserve may already be present in asymptomatic patients with aortic regurgitation and normal ejection fraction (EF), thus indicating the need for frequent and accurate assessments of the left ventricular function for the early detection of systolic dysfunction. OBJECTIVE: To analyze if increments in EF with low dose dobutamine could predict surgery and/or death in patients with aortic regurgitation. METHDOS: Dobutamine-stress echocardiography was performed in 24 patients with aortic regurgitation in order to analyze whether EF increments at low dobutamine doses could predict the need for surgery and/or death in this group of patients. RESULTS: Mean age was 37.8±16.8 years and 16 patients (66%) were male. EF increased from a mean baseline value of 62.3±7.9% to 71.5±10.5% at a dobutamine dose of 20 µg/kg/min (p<0.001). The patients were followed-up for 36.6±20.1 months; two patients died (one of cardiovascular death) and five underwent cardiac surgery. Baseline EF was correlated with surgery and death in the follow-up of patients. CONCLUSION: Baseline EF was correlated with surgery or death in the follow-up of young patients with aortic regurgitation. However, the percentage increase in EF at low dobutamine doses did not allow us to predict events in these patients.

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Artigo Original

Piloerection: a side effect of intravenous administration of dobutamine

BACKGROUND: When a dobutamine stress echocardiogram is performed, piloerection is frequently found in the scalp area. OBJECTIVE: The aim of the present study was to establish the incidence of this phenomenon and its association with other clinical findings. METHODS: A total of 218 consecutive patients that underwent dobutamine stress echocardiography in our department were included in the study. RESULTS: Piloerection was present in 42.2% of the sample. No correlations could be established between piloerection and gender, result of the stress test or other side effects. A statistically significant correlation was established with the age of the patients: piloerection was present in 73% of patients aged 50 years or younger. It appears most often with a dobutamine dose of 10 µg/kg/min. CONCLUSION: Piloerection is a frequent side effect of dobutamine infusion, particularly in patients aged 50 or less; it usually precedes the increase in heart rate caused by dobutamine; therefore, it is an early and clear indication that the intravenous set is working properly. Also, the previous warning of its possible appearance may contribute to the patient’s well-being.

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Artigo Original

Internal thoracic artery graft (ITAG): patency and functional status at rest and during dobutamine-stress echocardiography

José Sebastião de Abreu et al. Tereza Cristina Pinheiro Diógenes André Luís de Castro Abreu José Erirtônio Façanha Barreto … José Maria Bonfim de Morais Marília Esther Benevides de Abreu Jorge Henrique Azevedo Pinto José Nogueira Paes Júnior

BACKGROUND: The patent internal thoracic artery graft (ITAG) usually has a diastolic fraction (DF) > 50% of the flow. The functional assessment can be evaluated by the coronary reserve index (CRI). OBJECTIVE: The objective was to evaluate the patency and functional status of the ITAG through echocardiography and Doppler. METHODS: Data from sixty-six patients who underwent dobutamine-stress echocardiography (DSE) were prospectively collected and analyzed. Group I (GI) had 49 ITAG without stenosis, Group II (GII), 10 ITAG with significant stenosis (> 50% and 50%, it was observed in 49 ITAG (GI= 40, GII= 8 and GIII= 1) at rest and in 61 ITAG (GI=49, GII=10 and GIII=2) during DSE. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were respectively, 81%, 86%, 98%, 35% and 82%, and 100%, at rest and 71%, 97%, 100% and 97% in the DSE. The ITAG with DF>50% at rest were patent and the ones with DF1.8 for a good functional status, it was observed in 42 ITAG (39 from GI, 2 from GII and 1 from GIII), determining sensitivity=79%, specificity=85.7%, PPV=94%, NPV=59% and accuracy= 80.9%. The CRI in GI was higher (p= 0.02) than in GII or GIII. CONCLUSION: In our study, the non-invasive assessment of the ITAG was effective to verify the patency and the functional status.

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Comunicação Breve

Topical betablocker use can result in inconclusive dobutamine stress echocardiography in patients with glaucoma

Adriana Cordovil et al. Fernando Q. Matos Orlando Campos Filho Augusto Paranhos Jr. … Ana Clara T. Rodrigues Márcia V. Albernaz Angelo A. V. de Paola Antonio Carlos C. Carvalho

Dobutamine stress echocardiography is a well-established method to assess coronary artery disease, of which sensitivity has been enhanced by adding atropine at the end of the protocol. Individuals with glaucoma, a disease with a high prevalence in patients with cardiac diseases older than 40 years, cannot benefit from the use of atropine as it is contraindicated for this group of patients. Additionally, these individuals are often treated with topical betablockers (eye drops), which can have systemic effects by decreasing cardiac frequency, blood pressure and pulmonary capacity. The aim of our study was to verify whether a possible systemic effect caused by the use of these eye drops, yielding a low chronotropic response, could result in inconclusive dobutamine stress echocardiography in patients with glaucoma.

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Artigo Original

Safety and feasibility of dobutamine-atropine stress echocardiography in octogenarian patients

José Sebastião de Abreu et al. Tereza Cristina Pinheiro Diógenes Ana Gardenia Liberato Ponte Farias José Maria Bonfim de Morais José Nogueira Paes Júnior

OBJECTIVE: To assess the feasibility and safety of dobutamine-atropine stress echocardiography (DASE) in octogenarians. METHODS: We evaluated 5,467 DASE which were distributed in two groups: group I (GI) with 203 DASE performed in octogenarians, and group II (GII), the control group, with 5,264 DASE. The mean age of GI and GII was 83±3 (80-95) and 59±11 (17-79) years, respectively. DASE parameters that were prospectively collected, were compared and analyzed. RESULTS: The percentage of patients that achieved maximum heart rate was 63.5% in GI and 41% in GII (p<0.001), and GI patients required less atropine compared to GII (GI=47%, GII=78%, p<0.001).The presence of chest pain (GI=13%, GII=15.6%, p=0.429) and DASE positive for myocardial ischemia (GI=20.7%, GII=16.9%, p=0.296) were not statistically different between the two groups. However, concomitant positive DASE and absence of chest pain (GI=17%, GII=11%, p=0.029) was higher in GI. The incidence of premature beats in GI was higher than in GII (GI=47.8%, GII=27.6%, p<0.001), and there were more supraventricular tachyarrhythmias (ST) in GI than in GII (GI=5.9%, GII=1.9%, p=0.001). Out of 11 ST that happened in GI, 9 reverted spontaneously. There weren't either deaths or acute myocardial infarction. Ventricular fibrillation only happened in GII (2 cases, 0.03%). CONCLUSION: In the present study, octogenarians achieved maximum heart rate more frequently despite the lesser amount of atropine that they required for DASE completion. Moreover, in this elderly population, there was a higher correlation between positive DASE and absence of chest pain. Although octogenarians did present more heart rhythm disturbs, they usually resolved spontaneously. In our study, DASE proved to be feasible and safe in octogenarians.

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Artigo Original

Cost analysis of the treatment of acute decompensated heart failure: levosimendan versus dobutamine

Mucio Tavares Oliveira Jr et al. Wilson Follador Maria Lucia Orlandi Martins Roberta Canaviera … Rosana Lima Garcia Tsuji Airton Scipioni Antonio Carlos Pereira Barretto

OBJECTIVE: To assess whether the treatment with levosimendan is more expensive than the usual one with dobutamine, since price of medications does not usually represent the greatest expense in the treatment of cardiac decompensation. METHODS: The cost of treatment of 18 inpatients with cardiac decompensation, 9 of which treated with dobutamine (dobuta group) and 9 with levosimendan (levo group), was compared. Groups were similar concerning age, sex, functional class and cardiac function. RESULTS: Treatment costs were similar for both groups. In the levo group, the costs with the drug were higher than in the dobuta group, but those related to the length of stay in intensive care unit and to the material used during admission were lower. Levo – drug: R$ 5,414.00; material: R$ 399.90; hospital daily rates: R$ 5,061.20; professional honorarium: R$ 3,241.80; total costs: R$ 14,117.00. Dobuta – drug: R$ 2,320.10; materials: R$ 1,665.70; hospital daily rates: R$ 6,261.90; professional honorarium: R$ 3,894.30; total costs: R$ 14,142.00. CONCLUSION: Despite the higher price of levosimendan, the global cost of the treatment was similar for patients who were treated either with dobutamine or levosimendan. Patients who were treated with levosimendan had a shorter length of stay in intensive care unit.

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Original Article

Assessment of splanchnic perfusion with gastric tonometry in the immediate postoperative period of cardiac surgery in children

Renato Lopes de Souza et al. Werther Brunow de Carvalho Miguel Angel Maluf Antonio Carlos Carvalho

OBJECTIVE – A prospective, nonrandomized clinical study to assess splanchnic perfusion based on intramucosal pH in the postoperative period of cardiac surgery and to check the evolution of patients during hospitalization. METHODS – We studied 10 children, during the immediate postoperative period after elective cardiac surgery. Sequential intramucosal pH measurements were taken, without dobutamine (T0) and with 5mcg/kg/min (T1) and 10 (T2) mcg/kg/min. In the pediatric intensive care unit, intramucosal pH measurements were made on admission and 4, 8, 12, and 24 hours thereafter. RESULTS – The patients had an increase in intramucosal pH values with dobutamine 10mcg/kg/min [7.19± 0.09 (T0), 7.16±0.13(T1), and 7.32±0.16(T2)], (p=0.103). During the hospitalization period, the intramucosal pH values were the following: 7.20±0.13 (upon admission), 7.27±0.16 (after 4 hours), 7.26±0.07 (after 8 hours), 7.32±0.12 (after 12 hours), and 7.38±0.08 (after 24 hours), (p=0.045). No deaths occurred, and none of the patients developed multiple organ and systems dysfunction. CONCLUSION – An increase in and normalization of intramucosal pH was observed after dobutamine use. Measurement of intramucosal pH is a type of monitoring that is easy to perform and free of complications in children during the postoperative period of cardiac surgery.

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Artigo Original

Safety and feasibility of dobutamine-atropine stress echocardiography

Wilson Mathias Jr et al. Léa Paula Beneti Fabio Cesar dos Santos Renata Duprat … Ailton Beraldo Manoel Adan Gil José Lázaro Andrade Eulógio Martinez

PURPOSE: To study the safety and feasibility of dobutamine-atropine stress echocardiography (DASE) in patients with known or suspected coronary artery disease. METHODS: There were 3,000 DASE that were studied in a prospective fashion. All symptons and side effects were stored in a data base format. RESULTS: Major test-related complications observed included one case of myocardial infarction, four cases of sustained ventricular tachycardia and five cases of atropine intoxication. There was no death or ventricular fibrillation as a direct or indirect consequence of the test. The infusion protocol allowed to us to examine patients using beta blockers, and led to 95% feasibility. CONCLUSION: DASE is a safe and feasible method for the study of patients with suspected or known coronary artery disease.

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Artigo Original

Prognostic value of dobutamine-atropine stress echocardiography

Mathias Jr Wilson et al. Ulisses Stella Flávio Baruta Adriana Cordovil … José Lázaro Andrade Antonio Carlos Carvalho Expedito Ribeiro Renata Duprat Eulógio Martinez

PURPOSE: To determine the prognostic value of dobutamine-atropine stress echocardiography (DASE). METHODS: We studied 452 consecutive patients at high risk for coronary artery disease, using DASE. They were followed during a mean period of 23 months. RESULTS: There were 9 cardiac deaths and 2 acute myocardial infarctions in the group of patients with positive tests, and there were 2 myocardial infarctions and 1 cardiac death in patients with negative DASE. CONCLUSION: We conclude that DASE reliably identifies patients at high risk for hard cardiac events.

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