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(Circulation. 1995;92:3453-3463.)
© 1995 American Heart Association, Inc.

Articles

Dobutamine-Atropine Stress Echocardiography in Asymptomatic Healthy Individuals

The Relativity of Stress-Induced Hyperkinesia

Steen Carstensen, MD; Samir M. Ali, MD; Frank V. Stensgaard-Hansen, MD; Jens Toft, MD; Stig Haunsø, MD; Henning Kelbæk, MD; Kari Saunamäki, MD

From the Department of Medicine B (S.C., S.M.A., F.V.S.-H., S.H., H.K., K.S.) and the Copenhagen City Heart Study, Epidemiological Research Unit, Department 7121, and the Department of Clinical Physiology and Nuclear Medicine (J.T.), Rigshospitalet, University of Copenhagen (Denmark).

Correspondence to Steen Carstensen, MD, Department of Medicine B 2142, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen DK-2100, Denmark.

Background Interpretation of dobutamine-atropine stress echocardiography (DASE) is based on the assumption that the normal response to dobutamine-atropine infusion is characterized by increased systolic thickening and motion of the left ventricular (LV) walls, whereas a reduction or no change is considered indicative of coronary artery disease. The aim of this study was to quantitatively assess changes in LV dimension and wall motion patterns during DASE in a healthy population.

Methods and Results Forty-two asymptomatic voluntary subjects (22 men) with a mean age of 59 years (range, 31 to 79 years) and a likelihood of <5% for coronary artery disease underwent DASE with digital recording of two-dimensional and M-mode echocardiography at baseline and low-dose and peak infusion rates. Mean end-diastolic and end-systolic LV diameters and areas decreased and wall thicknesses increased progressively throughout the test. Wall motion and thickening increased from baseline to low-dose infusion in nearly all subjects. However, from low-dose to peak infusion, the mean absolute wall motion and relative wall thickening decreased by 13.1% (95% CI, 2.7 to 23.5) and 21.4% (95% CI, 6.4 to 36.4) regardless of age, sex, or use of atropine. Changes in fractional shortening and absolute wall thickening varied considerably, with a decrease observed in 15 and 13 individuals (36% and 31%), respectively.

Conclusions In healthy subjects, measures of wall motion and wall thickening increased from baseline to low-dose infusion but decreased from low-dose to peak infusion. These findings call for revision of the assumptions on which the common analysis of DASE is based.

Key Words: echocardiography • stress • dobutamine

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