Clinical transplantation proceedingsIs atropine infusion necessary to achieve the target heart rate in heart transplant patients during dobutamine stress echocardiography?
Section snippets
Patients and methods
From August 2001 to February 2002, the present study includes 100 consecutive DSE that were performed on patients without wall motion abnormalities induced during the test. Among these studies, 50 were performed in patients who had undergone orthotopic heart transplant using the standard technique (44 men; mean age, 55 ± 13.2 years; mean time post transplantation, 55.4 ± 35 months) and were referred to us for screening for cardiac allograft vasculopathy. The other 50, a control group, were
Results
The baseline HR was significantly higher among HTXp than non-HTXp (85.96 ± 6.2 vs 73.14 ± 1.8 bpm; P < .0001). The mean peak dosage of dobutamine needed to achieve target HR was higher for the control group (33.4 ± 1.13 vs 25.6 ± 1.46 μg/kg per min; P < .0001). Figure 1 illustrates the chronotropic responses to graded dobutamine infusion in both groups. The dose-response curves showed significant differences between the groups; by analysis of variance (by group and dose), the change for 1 dose
Discussion
Our data show that: (1) HTXp exhibit an augmented chronotropic response to β-adrenergic stimulation by dobutamine, similar to previous reports2, 3; (2) the dobutamine dose to achieve the target HR was significantly lower in HTXp; (3) there was a poor response to atropine administration in HTXp; (4) no relation was found between time posttransplantation and mean peak dose during DSE; and (5) dobutamine infusion is safe in HTXp.
Although sympathetic reinnervation has been demonstrated
References (8)
- et al.
J Am Coll Cardiol
(1989) - et al.
Chest
(1999) - et al.
Circ Respir
(1985) - et al.
Circulation
(1995)
Cited by (5)
The risk of adverse events associated with atropine administration during dobutamine stress echocardiography in cardiac transplant patients: A 28-year single-center experience
2013, Journal of Cardiac FailureCitation Excerpt :A few studies of atropine use in heart transplant patients undergoing DSE have been conducted, but they were smaller and did not primarily focus on the risk of adverse events.5,11,14–17 A retrospective study by Kociolek et al included 21 transplant patients who received atropine during DSE, and a similar study by Flox et al included 14 transplant patients who also received both agents.11,16 The patient populations in those studies were similar to ours, though the study by Flox et al did not include patients using beta-blockers.
Spanish heart transplant units consensus conference
2007, Revista Espanola de Cardiologia SuplementosDobutamine stress echocardiography after cardiac transplantation: Implications of donor-recipient age difference
2015, Echo Research and Practice