الفهرس 
STRESS ECHOCARDIOGRAPHYOnly 14 pages are availabe for public view
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Abstract
Dobutamine-atropine stress echocardiography (DASE) is well established in clinical practice, as it is considered to be one of the main methods of imaging to determine the presence of myocardial ischemia.
Currently, the use of the 3 min. protocol has become the most popular, beginning at 5 mcg/kg/min infusion of dobutamine and reaching a maximum dose of 40 mcg/kg/ min, with the addition of atropine from the final stage on. Even though atropine has been used more often at the end of the stress test to increase heart rate and accuracy, this agent is usually administered during or soon after the maximum dose of dobutamine, with the patients receiving prolonged amine infusions which may increase side effects. Besides, the test time is often extended.
Considering that a significant number of patients (32%) do not reach a dobutamine stress echocardiographic end point with the standard protocol (Weissman et al.,1997), and the increasing use of Beta blockers as anti-ischemic or anti-hypertensive medication in the last decade, the following question should be considered: Are the protocols employed in stress echocardiography still in agreement with current medical practice ?
If the range of the ideal heart rate, which is of extreme importance to the accuracy of the method, is compromised, then the need for a more homogenous protocol which counterbalances the employed therapeutic effect becomes relevant so as to avoid damage to the diagnostic and prognostic information of the test.
The aim of this study was to assess the sensitivity, validity & safety of atropine when initiated early during dobutamine stress echocardiography in relation to its later usage.
Forty consecutive patients were examined by dobutamine stress echocardiography. The patients were randomly divided into two protocols of study