Chest ACCP Member Benefits
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Guest Access | Sign In via User Name/Password
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF) Free
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Article Archive
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via ISI Web of Science (14)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Elhendy, A.
Right arrow Articles by Roelandt, J. R. T. C.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Elhendy, A.
Right arrow Articles by Roelandt, J. R. T. C.
(Chest. 2000;117:649-656.)
© 2000 American College of Chest Physicians

Safety, Hemodynamic Profile, and Feasibility of Dobutamine Stress Technetium Myocardial Perfusion Single-Photon Emission CT Imaging for Evaluation of Coronary Artery Disease in the Elderly*

Abdou Elhendy, MD, PhD; Ron T. van Domburg, PhD; Jeroen J. Bax, MD, PhD; Roelf Valkema, MD, PhD; Ambroos E. M. Reijs, MSc; Eric P. Krenning, MD, PhD and Jos R. T. C. Roelandt, MD, PhD

* From the Thoraxcenter (Drs. Elhendy, van Domburg, Bax, and Roelandt) and the Department of Nuclear Medicine (Drs. Valkema and Krenning and Mr. Reijs), University Hospital Rotterdam-Dijkzigt, Rotterdam, The Netherlands. This study was supported in part by the Department of Cardiology, Cairo University Hospital, Cairo, Egypt.

Correspondence to: Abdou Elhendy, MD, PhD, Thoraxcenter, Ba 302, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands


   Abstract
TOP
 Abstract
Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Objectives: Cardiovascular disease is the leading cause of morbidity and mortality in the elderly. The evaluation of coronary artery disease by exercise stress testing is frequently limited by the patient’s inability to exercise. Although pharmacologic stress testing with dobutamine is an alternative, the safety of dobutamine myocardial perfusion scintigraphy in the elderly has not been previously studied.

Patients and methods: We studied the safety and feasibility of dobutamine (up to 40 µg/kg/min)-atropine (up to 1 mg) stress myocardial perfusion scintigraphy using technetium single-photon emission CT imaging in 227 patients >= 70 years old (mean ± SD age, 75 ± 4 years). A control group of 227 patients < 70 years old (mean age, 55 ± 11 years; matched for gender, prevalence of previous infarction, ß-blocker therapy, and severity of resting perfusion abnormalities) was studied to assess age-related differences in the safety and the hemodynamic response. A feasible test was defined as the achievement of the target heart rate and/or an ischemic end point (angina, ST-segment depression, or reversible perfusion abnormalities).

Results: No myocardial infarction or death occurred during the test. The target heart rate was achieved more frequently in the elderly patients (87% vs 79%; p < 0.05). The elderly patients had a higher prevalence of supraventricular tachycardia (7% vs 1%; p < 0.005) and premature ventricular contraction (74% vs 32%; p < 0.005) during the test, as compared to the younger patients. There was a trend to a higher prevalence of ventricular tachycardia (5% vs 2%) and atrial fibrillation (3% vs 0.4%) in the elderly patients. Arrhythmias were terminated spontaneously by termination of dobutamine infusion or by administration of metoprolol. Independent predictors of supraventricular tachyarrhythmias and ventricular tachycardia were older age (p < 0.001; {chi}2, 9.8) and myocardial perfusion defect score at rest (p < 0.01; {chi}2, 6.8) respectively, by using a multivariate analysis of clinical and stress test variables. Elderly patients had a higher prevalence of systolic BP drop > 20 mm Hg during the test (37% vs 12%; p < 0.05). The test was terminated due to hypotension in 2% of the elderly patients and in 1% of the control group. Age was the most powerful predictor of hypotension (p < 0.005; {chi}2, 10.3). The test was considered feasible in 216 elderly patients (95%) and in 209 patients of the control group (92%).

Conclusion: Dobutamine-atropine stress myocardial perfusion scintigraphy is a highly feasible method for the evaluation of coronary artery disease in the elderly. Elderly patients have a higher risk for developing hypotension and supraventricular tachyarrhythmias during a dobutamine stress test. However, dobutamine-induced hypotension is often asymptomatic and rarely necessitates the termination of the test.

Key Words: arrhythmias • coronary artery disease • dobutamine • elderly • myocardial perfusion • safety


   Introduction
TOP
 Abstract
 Introduction
Materials and Methods
 Results
 Discussion
 References
 
Cardiovascular disease is the leading cause of morbidity and mortality in the elderly population.1 2 Recent advances in revascularization proce-dures have led to an increase in the number of elderly patients undergoing coronary artery bypass grafting or coronary angioplasty, with a clear benefit on short-term and long-term survival.1 4 Therefore, stress testing is justified for the diagnosis and functional evaluation of coronary artery disease in this population to select patients who are candidates for further interventions. Exercise stress testing is the most widely used noninvasive method for evaluation of coronary artery disease.5 However, a larger proportion of the elderly population may be unable to perform exercise stress test due to the higher prevalence of pulmonary airway, degenerative joint, and peripheral vascular diseases, and the reduced physical fitness in the elderly as compared to the younger population.1 6 Pharmacologic stress testing in conjunction with myocardial perfusion imaging is an established method for the evaluation of coronary artery disease in patients with limited exercise capacity.7 8 9 10 11 12 13 Dobutamine perfusion imaging is a feasible method particularly in patients with obstructive airway disease who are not candidates for a vasodilator stress test.9 10 11 12 13 Numerous studies have reported the safety of dobutamine stress echocardiography14 15 and myocardial perfusion scintigraphy.9 10 However, the safety of dobutamine perfusion imaging in the elderly has not been reported. Elderly patients are at a higher risk for developing spontaneous and exercise-induced arrhythmias,16 17 as well as impairment of compensatory mechanisms for hypotension. Therefore, these patients may be more vulnerable to hypotension and arrhythmias during a dobutamine stress test. The aims of this study are as follows: (1) to assess the safety, feasibility, and hemodynamic profile of dobutamine stress myocardial perfusion scintigraphy in the elderly population with limited exercise capacity who are referred for the diagnosis or functional evaluation of coronary artery disease; and (2) to assess the age-specific differences in the safety and hemodynamic profile by comparing these parameters in the elderly with a control group of younger patients matched for the major clinical characteristics that might influence the safety and feasibility of the test.


   Materials and Methods
TOP
 Abstract
 Introduction
 Materials and Methods
Results
 Discussion
 References
 
Patient Population
Study population comprised 227 elderly patients >= 70 years old with limited exercise capacity who were referred for evaluation of myocardial ischemia by dobutamine stress-technetium myocardial perfusion scintigraphy between January 1994 and January 1999 in our imaging laboratory. A group of 227 patients < 70 years old matched for gender, medication with ß blockers, previous myocardial infarction, and fixed myocardial perfusion defect score served as control subjects. The test was not performed in patients with severe heart failure, significant valvular heart disease, severe hypertension (BP >= 180/110 mm Hg), hypotension (BP < 90/60 mm Hg), and unstable chest pain. All patients gave verbal informed consent to undergo the study. The Hospital Ethical Committee approved the use of the dobutamine stress test for evaluation of coronary artery disease.

Clinical Features: The clinical characteristics of patients >= 70 years and < 70 years old are summarized in Table 1 . There was no significant difference between both groups regarding the prevalence of hypertension, diabetes mellitus, cigarette smoking, previous revascularization, medications at the day of the test, or indications of stress testing. Hypercholesterolemia was more prevalent in the younger group.


View this table:
[in this window]
[in a new window]

  		Table 1.. Clinical Features of Patients >= 70 and < 70 Years Old Undergoing Dobutamine-Atropine Stress Myocardial Perfusion Scintigraphy*

 
Dobutamine Stress Test
Dobutamine was infused through the antecubital vein starting at a dosage of 5 µg/kg/min followed by 10 µg/kg/min (3-min stages), increasing by 10 µg/kg/min every 3 min to a maximum of 40 µg/kg/min. Atropine (up to 1 mg) was given to patients who did not achieve 85% of maximal heart rate predicted for age and gender (220 - age [in years] beats/min in men and 200 - age beats/min in women) and dobutamine infusion was continued. The ECG was monitored throughout dobutamine infusion and was recorded every minute. Cuff BP was measured at rest, every 3 min during stress, and at maximal stress. The test was interrupted if severe chest pain, horizontal or downsloping ST-segment depression > 2 mm, ventricular or supraventricular tachycardia consisting of >= 10 complexes, hypertension (BP >= 240/120 mm Hg), systolic BP fall > 40 mm Hg, or any intolerable side effect regarded as being due to dobutamine occurred during the test. IV metoprolol (from 1 to 5 mg) was used to reverse the effects of dobutamine if these did not revert quickly.

Single-Photon Emission CT Imaging
Approximately 1 min before the termination of the stress test, IV 99mtechnetium sestamibi, 370 MBq, (in 230 patients) or tetrofosmin (in 224 patients) was administered. The acquisition of stress single-photon emission CT imaging was started 1 h after the test. Resting studies were performed 24 h after the stress study and 1 h after injection of 370 MBq of sestamibi or tetrofosmin. The same isotope administered during stress was used for rest studies. An equal number of patients in each group received the same tracer. Image acquisition and interpretation were performed according to the previously described protocols.10 For each study, six oblique (short-axis) slices from the apex to the base and three sagittal (vertical long-axis) slices from the septum to the lateral wall were defined. Each of the six short-axis slices were divided into eight equal segments. The interpretation of the scan was performed using visual analysis assisted by the circumferential profiles analysis. Stress and rest tomographic views were reviewed in side-by-side pairs by an experienced observer who was unaware of the patients’ clinical data. A reversible perfusion defect was defined as a perfusion defect on stress images that partially or completely resolved at-rest images in two or more contiguous segments or slices. This was considered diagnostic of ischemia. A fixed perfusion defect was defined as a perfusion defect on stress images in two or more contiguous segments or slices that persisted on rest images. Six major myocardial segments were identified: anterior, inferior, septal anterior, septal posterior, posterolateral, and apical. To assess the severity of perfusion abnormalities, each of the six major left ventricular segments was scored using a 4-grade scoring method (0 = normal, 1 = slightly reduced, 2 = moderately reduced, and 3 = severely reduced or absent uptake). The perfusion score was derived using the summation of the scores of the six myocardial segments for rest and stress images. Ischemic score was obtained by subtracting the rest score from the stress score. The rest score (fixed perfusion defect) was considered as the infarction score.10 A dobutamine stress test was considered feasible if the patient could achieve 85% of the maximal heart rate predicted for age and/or when an ischemic end point (angina, ST-segment depression, reversible perfusion abnormalities) was reached.

Statistical Analysis
Unless specified, data are presented as mean values ± SD. The {chi}2 test was used to compare differences between proportions. The Student’s t test was used for analysis of continuous data. Stepwise logistic regression models were used to identify independent predictors of hypotension and arrhythmias. Differences were considered significant if the null hypothesis could be rejected at the 0.05 probability level.


   Results
TOP
 Abstract
 Introduction
 Materials and Methods
 Results
Discussion
 References
 
Hemodynamic Response
Table 2 summarizes the hemodynamic and dobutamine stress test variables in both groups. Heart rate increased significantly from rest to peak stress in both groups (p < 0.0001). Systolic BP increased significantly in the younger group (p < 0.0001), but not in the elderly group. Diastolic BP dropped more significantly from rest to peak stress in the elderly patients compared to the younger patients (p < 0.05). Elderly patients had a higher baseline systolic BP, a lower peak heart rate, a lower peak rate pressure product, and a higher prevalence of systolic BP drop > 20 mm Hg. There was no significant difference between both groups regarding the maximal dobutamine dose, frequency of atropine administration, incidence of ST-segment depression, angina, symptomatic hypotension, and minor side effects during the test (Table 3 ).


View this table:
[in this window]
[in a new window]

  		Table 2.. Hemodynamic Data of Patients >= 70 and < 70 Years Old Undergoing Dobutamine-Atropine Stress Myocardial Perfusion Scintigraphy*

 

View this table:
[in this window]
[in a new window]

  		Table 3.. Symptoms of Patients >= 70 and < 70 Years Old During Dobutamine-Atropine Stress Myocardial Perfusion Scintigraphy*

 
The prevalence of various types of arrhythmias during the test is shown in Figure 1 . Ventricular and supraventricular tachycardia were terminated in all cases spontaneously by stopping dobutamine infusion or by administration of metoprolol. Ventricular tachycardia consisting of >= 10 beats occurred in two patients (one patient in each group). Elderly patients had a significantly higher prevalence of supraventricular tachycardia and premature ventricular contractions and a trend to a higher prevalence of atrial fibrillation (p = 0.1) and ventricular tachycardia (p = 0.2), compared to the younger patients.



View larger version (11K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 1.. The prevalence of various types of arrhythmias during dobutamine stress test in patients >= 70 years old and < 70 years old. y = years old; PACs = premature atrial contractions; PVCs = premature ventricular contractions; SVT = supraventricular tachycardia; AF = atrial fibrillation; VT = ventricular tachycardia.

 
Test End Points
The reasons for termination of the test in both groups are listed in Table 4 . The test was terminated because of reaching the target heart rate more frequently in the elderly group. The test was terminated due to angina, ST-segment changes, arrhythmias, hypotension, hypertension, and other minor side effects in a similar proportion of both groups, whereas the younger patients had a higher rate of failure to reach the target heart rate, despite the maximal dose of dobutamine and atropine. Nineteen elderly patients and 34 of the younger patients could not achieve the target heart rate and had no angina or ST-segment depression. Reversible perfusion defects were detected in 8 and 16 of these patients, respectively, resulting in a feasible test (achievement of the target heart rate or an ischemic end point) in 216 elderly patients (95%) and in 209 of the younger patients (92%).


View this table:
[in this window]
[in a new window]

  		Table 4.. Reasons for Termination of Dobutamine Stress Testing in Patients >= 70 and < 70 Years Old*

 
Myocardial Perfusion Scintigraphy
The prevalence of different perfusion scintigraphic patterns in both groups is shown in Figure 2 . There was no significant difference between both groups regarding the prevalence of reversible or fixed perfusion defects.



View larger version (14K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 2.. The prevalence of myocardial perfusion abnormalities in patients >= 70 years old and < 70 years old undergoing dobutamine stress test. PD = perfusion defect; see Figure 1 for abbreviation.

 
Gender Differences
Women had a higher prevalence of normal myocardial perfusion (56% vs 23%; p < 0.001), a lower infarction score (1.1 ± 2.2 vs 3 ± 3; p < 0.0001), and a lower ischemic score (0.8 ± 1.7 vs 1.6 ± 2.4; p < 0.0001) compared to men, respectively. There was no significant difference regarding the stress rate pressure product between men and women in the elderly group (18,707 ± 4,508 vs 18,304 ± 4,027) or in the younger group (19,967 ± 4,223 vs 19,940 ± 4,810), respectively.

Sestamibi vs Tetrofosmin Studies
Patients who underwent sestamibi imaging had a higher ischemic score than patients who underwent tetrofosmin imaging (1.4 ± 2.1 vs 0.8 ± 1.5; p < 0.005). The infarction score was not significantly different between both groups (2.1 ± 2.7 vs 1.9 ± 2.8, respectively; p = 0.4)

Predictors of Hypotension and Arrhythmias
Clinical and stress test variables included in the multivariate analysis model were as follows: age, gender, history of angina, previous myocardial infarction, hypertension, baseline systolic BP, medications, maximal dobutamine dose, peak heart rate, abnormal perfusion, fixed and ischemic perfusion defect scores, and angina during the test. Independent predictors of systolic BP drop > 20 mm Hg during stress were older age (p < 0.005; {chi}2, 10.3), a higher stress heart rate (p < 0.01; {chi}2, 7.7), a higher baseline systolic BP (p < 0.05; {chi}2, 5.1), medication with calcium antagonists (p < 0.05; {chi}2, 4.1), and a higher dobutamine dose (p < 0.05; {chi}2, 4.7). The only independent predictor of supraventricular tachyarrhythmias (supraventricular tachycardia and atrial fibrillation) was older age (p < 0.001; {chi}2, 9.8). The infarction (rest perfusion defect) score was the only independent predictor of ventricular tachycardia (p < 0.01; {chi}2, 6.8).


   Discussion
TOP
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
References
 
As far as we are concerned, this is the first study that evaluates the safety and feasibility of dobutamine stress myocardial perfusion scintigraphy in the elderly. The mean age of the elderly patients in our study was 75 years. These patients represented the usual candidates for pharmacologic stress testing at this age group who are unable to perform an exercise stress test. Referring patients at this age for the noninvasive evaluation of coronary artery disease reflects the confidence of physicians regarding the beneficial effects of guided therapeutic interventions in the elderly. A group of younger patients was used as a control group in this study. The patients were matched for the major clinical features that may have an influence on the hemodynamic profile and the safety of the test. The patients were matched for gender because previous studies have shown gender-related difference in the chronotropic response and safety.18 19 The severity of resting perfusion abnormalities (and presumably left ventricular dysfunction) was also selected among matching parameters because the extent of myocardial perfusion abnormalities was reported to predict complications during the test.10 Finally, the patients were matched for the treatment with ß blockers because these agents interfere with the chronotropic response to dobutamine and therefore may reduce the feasibility of the test, increase the need for atropine administration, or reduce the prevalence and severity of inducible ischemia.20 On the other hand, the intake of ß blockers may be associated with more complications, presumably because these medications are prescribed to patients with a higher risk profile, as are patients with previous myocardial infarction, typical angina, and hypertension.19 Therefore, matching the two groups allowed an independent detection of any possible age-specific difference in the hemodynamic and safety profile of the dobutamine stress test. This matching explains the nearly similar clinical features of the two groups of patients, as shown in Table 1 . Our study demonstrated that dobutamine myocardial perfusion scintigraphy is a highly feasible method for the noninvasive evaluation of coronary artery disease in the elderly. Ninety-five percent of these patients could achieve the end point of target heart rate and/or an ischemic end point.

Heart Rate Response:
A higher proportion of the elderly patients could achieve the target heart rate. This may be related to a higher dose-related response due to age-related changes in the pharmacokinetics of the drugs. Another explanation is the lower calculated target heart rate in the elderly that renders the achievement of the target heart rate easier in older patients.5 This can also explain the lower peak heart rate in the elderly. Despite the fact that previous studies have demonstrated that elderly subjects have a reduced sensitivity to sympathetic stimulation,21 it has been recently shown that the cardiac chronotropic response to ß-receptor adrenergic stimulation is not reduced in the elderly.22

BP Response:
Systolic BP increased significantly from rest to peak stress in the younger patients but not in the elderly patients. Diastolic BP dropped more significantly from rest to peak stress in the elderly patients compared to the younger patients. Additionally, the prevalence of hypotension during the test was significantly higher in the elderly patients. However, most of the episodes of hypotension were asymptomatic, and the test was terminated because of hypotension only in five patients (2%). The test was terminated because of marked systolic BP increase in two elderly patients and in one younger patient. The impairment of systolic BP response to dobutamine in the elderly patients may be explained by different mechanisms. These include the impairment of compensatory mechanism for hypotension with aging,23 rendering the patients susceptible to hypotension induced by the action of dobutamine on ß2 receptors with subsequent peripheral vasodilation. It has also been demonstrated that elderly subjects maintain cardiac output during exercise by an increase in the end-diastolic dimension.24 Since dobutamine infusion causes a significant reduction of the end-diastolic dimension,25 26 this may deprive the subject from this compensatory mechanism. Peripheral vasodilatation induced by dobutamine may further compromise diastolic filling of the left ventricle. This contention is supported by our finding that dobutamine dose and medication with calcium channel blockers were independent predictors of hypotension during the test. Finally, the elderly had higher baseline systolic BP compared to the younger patients. A higher baseline systolic BP was reported to predict hypotension during dobutamine stress test.14 19 In this study, both the age and the baseline systolic BP were independently associated with dobutamine-induced hypotension, which demonstrates that the higher baseline systolic BP in the elderly was contributing (but was not the sole underlying mechanism) to dobutamine-induced hypotension in the elderly.

Arrhythmias:
Elderly patients had a higher prevalence of supraventricular tachycardia (7% vs 1%), atrial fibrillation (3% vs 0.4%), and premature ventricular contraction (74% vs 32%) during the test compared to the younger patients. There was also a trend to a higher prevalence of ventricular tachycardia in the elderly (5% vs 2%). However, the tachycardia was terminated spontaneously by termination of dobutamine infusion or by administration of metoprolol. No myocardial infarction or death occurred in any patient. The test was terminated because of arrhythmias in four patients (three in the elderly and one in the younger patients). Age was an independent predictor of supraventricular tachyarrhythmias. Previous studies have demonstrated an increased prevalence of spontaneous and exercise-induced arrhythmias with aging,16 17 which might explain the higher prevalence of tachyarrhythmias (particularly supraventricular tachycardia and premature ventricular contractions) in the elderly patients in this study. A trend was found to a higher prevalence of ventricular tachycardia in the elderly. However, the severity of resting perfusion abnormalities (and, presumably, resting left ventricular dysfunction) was the only independent predictor of the occurrence of ventricular tachycardia. This may be explained by the higher probability of the presence of substrate for arrhythmias in patients with more severe left ventricular dysfunction.10

Studies of Dobutamine Stress Echocardiography in the Elderly:
Few reports are available regarding the safety of dobutamine stress echocardiography in the elderly. These studies included smaller numbers of patients compared to our study and did not compare the results with a control group,27 28 29 or compared the elderly with a younger population unmatched for clinical variables that may influence the safety and feasibility of the dobutamine stress test.19 Poldermans et al27 studied 179 patients >= 70 years old by dobutamine-atropine stress echocardiography. Arrhythmias induced during the test were atrial fibrillation in 2%, nonsustained ventricular tachycardia in 2%, and premature ventricular contractions in 21%. Hypotension occurred in 4%. No control group was studied. Baudhuin et al28 studied 63 patients >= 60 years old compared to 63 patients < 60 years old by dobutamine stress echocardiography. Sensitivity and specificity of dobutamine echocardiography for the diagnosis of coronary artery disease were 80% and 75% in the older patients and 79% and 88% in the younger patients, respectively. The prevalence of minor side effects was similar in both groups. Hiro et al19 studied 106 patients >= 75 years old by dobutamine stress echocardiography. Elderly patients had a higher prevalence of symptomatic hypotension and ventricular arrhythmias and a similar prevalence of supraventricular arrhythmias as compared to the younger patients. In their study, age was an independent predictor of hypotension but not of arrhythmias. However, the prevalence of different types of supraventricular or ventricular arrhythmias was not reported. Anthopoulos et al29 studied 120 elderly patients who underwent coronary angiography by dobutamine echocardiography. Sensitivity, specificity, and accuracy of dobutamine echocardiography for the diagnosis of coronary artery disease were 86.5%, 84%, and 86%, respectively. Although the use of echocardiographic imaging during dobutamine infusion was shown in previous studies to have a reasonable accuracy for the detection of coronary artery disease in the elderly, this study shows that myocardial perfusion imaging is a feasible alternative and should be considered, particularly in centers without adequate experience in stress echocardiographic imaging.

Clinical Implications and Conclusion:
Dobutamine-atropine stress myocardial perfusion scintigraphy is a highly feasible method for the evaluation of coronary artery disease in the elderly. The target heart rate is achieved more frequently during the test in elderly patients than in younger patients. Elderly patients are at increased risk for developing supraventricular tachyarrhythmias during a dobutamine stress test. Although dobutamine-induced hypotension is more frequent in elderly patients, it is often asymptomatic and rarely necessitates termination of the test.

Received for publication March 23, 1999. Accepted for publication August 13, 1999.


   References
TOP
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 

  1. Schulman, SP, Fleg, JL (1996) Stress testing for coronary artery disease in the elderly. Clin Geriatr Med 12,101-191[ISI][Medline]
  2. Coodley, EL (1988) Clinical spectrum and diagnostic techniques of coronary heart disease in the elderly. J Am Geriatr Soc 36,447-456[ISI][Medline]
  3. Gersh, BJ, Kronmal, RA, Schaff, HV, et al (1987) Comparison of coronary artery bypass surgery and medical therapy in patients 65 years of age or older. N Engl J Med 313,217-224[Abstract]
  4. Peterson, ED, Jollis, JB, Bebchuk, JD, et al (1994) Changes in mortality after myocardial revascularization in the elderly: the national Medicare experience. Ann Intern Med 121,919-927[Abstract/Free Full Text]
  5. Sheffield, LT (1988) Exercise stress test. Braunwald, E eds. Heart disease: a textbook of cardiovascular medicine 4th ed. ,223-241 WB Saunders Philadelphia, PA.
  6. Riley, CP, Oberman, A, Lampton, TD, et al (1970) Submaximal exercise testing in a random sample of elderly population. Circulation 62,43-52
  7. Lette, J, Tatum, JL, Fraser, S, et al (1995) Safety of dipyridamole testing in 73,806 patients: the multicenter dipyridamole safety study. J Nucl Cardiol 2,3-17[CrossRef][ISI][Medline]
  8. Cerqueria, MD, Verani, MS, Schwaiger, M, et al (1994) Investigations of the Multicenter Adenoscan Trials: safety profile of adenosine stress perfusion imaging; results from the adenoscan multicenter trial registry. J Am Coll Cardiol 23,384-389[Abstract]
  9. Dakik, HB, Vempathy, H, Verani, MS (1996) Tolerance, hemodynamic changes and safety of dobutamine stress perfusion imaging. J Nucl Cardiol 3,410-414[CrossRef][ISI][Medline]
  10. Elhendy, A, Valkema, R, van Domburg, RT, et al (1998) Safety of dobutamine-atropine stress myocardial perfusion scintigraphy. J Nucl Med 39,1662-1666[Abstract/Free Full Text]
  11. Pennell, DJ, Underwood, SR, Swanton, RH, et al (1991) Dobutamine thallium myocardial perfusion tomography. J Am Coll Cardiol 18,1471-1479[Abstract]
  12. Hays, JT, Mahmarian, JJ, Cochran, AJ, et al (1993) Dobutamine thallium-201 tomography for evaluating patients with suspected coronary artery disease unable to undergo exercise or vasodilator pharmacologic stress testing. J Am Coll Cardiol 21,1583-1590[Abstract]
  13. Geleijnse, ML, Elhendy, A, van Domburg, RT, et al (1996) Prognostic value of dobutamine-atropine stress technetium-99m sestamibi perfusion scintigraphy for evaluation of ischemic heart disease. J Am Coll Cardiol 28,447-454[Abstract]
  14. Elhendy, A, van Domburg, RT, Roelandt, JRTC, et al (1997) Safety and feasibility of dobutamine-atropine stress testing in hypertensive patients. Hypertension 29,1232-1239[Abstract/Free Full Text]
  15. Geleijnse, ML, Fioretti, PM, Roelandt, JRTC (1997) Methodology, feasibility safety and diagnostic accuracy of dobutamine stress echocardiography. J Am Coll Cardiol 30,595-606[Abstract]
  16. Maurer, MS, Shafrin, EA, Fleg, JL (1995) Prevalence and prognostic significance of exercise-induced supraventricular tachycardia in apparently healthy volunteers. Am J Cardiol 75,788-792[CrossRef][ISI][Medline]
  17. Mayuga, R, Arrington, CT, O’Connor, FC, et al (1996) Why do exercise-induced ventricular arrhythmias increase with age? Role of M-mode echocardiographic aging changes. J Gerontol A Biol Sci Med Sci 51,M23-M28[Abstract]
  18. Marcovitz, PA, Bach, DS, Mathias, W, et al (1993) Paradoxic hypotension during dobutamine stress echocardiography: clinical and diagnostic implications. J Am Coll Cardiol 21,1080-1086[Abstract]
  19. Hiro, J, Hiro, T, Reid, CL, et al (1997) Safety and results of dobutamine stress echocardiography in women versus men and in patients older and younger than 75 years of age. Am J Cardiol 80,1014-1020[CrossRef][ISI][Medline]
  20. Fioretti, PM, Poldermans, D, Salustri, A, et al (1994) Atropine increases the accuracy of dobutamine stress echocardiography in patients taking beta-blockers. Eur Heart J 15,355-360[Abstract/Free Full Text]
  21. Kendall, MJ, Woods, KL, Wilkins, MR, et al (1982) Responsiveness to beta-adrenergic receptor stimulation: the effects of age are cardioselective. Br J Clin Pharmacol 14,821-826[ISI][Medline]
  22. Poldermans, D, Boersma, E, Fioretti, PM, et al (1995) Cardiac chronotropic responsiveness to beta-adrenoceptor stimulation is not impaired in the elderly. J Am Coll Cardiol 25,995-999[Abstract]
  23. Lipsitz, LA (1985) Abnormalities in blood pressure homeostasis that contribute to falls in the elderly. Clin Geriatr Med 3,637-648
  24. Rodeheffer, RJ, Gerstenblith, G, Becker, LC, et al (1984) Exercise cardiac output is maintained with advancing age in healthy human subjects: cardiac dilatation and increased stroke volume compensate for a diminished heart rate. Circulation 69,203-213[Abstract/Free Full Text]
  25. Tanimoto, M, Pai, RG, Jintapakorn, W, et al (1995) Mechanism of hypotension during dobutamine stress echocardiography in patients with coronary artery disease. Am J Cardiol 76,26-30[CrossRef][ISI][Medline]
  26. Ruffolo, RR (1987) The pharmacology of dobutamine. Am J Med Sci 294,244-248[ISI][Medline]
  27. Poldermans, D, Fioretti, P, Boersma, E, et al (1994) Dobutamine-atropine stress echocardiography in elderly patients unable to perform an exercise test. Arch Intern Med 154,2681-2686
  28. Baudhuin, T, Marwick, T, Melin, J, et al (1993) Diagnosis of coronary artery disease in elderly patients: safety and efficacy of dobutamine echocardiography. Eur Heart J 6,799-803
  29. Anthopoulos, LP, Bonou, MS, Kardaras, FG, et al (1996) Stress echocardiography in elderly patients with coronary artery disease: applicability, safety and prognostic value of dobutamine and adenosine echocardiography in elderly patients. J Am Coll Cardiol 28,52-59[Abstract]



This article has been cited by other articles:


Home page
 HeartHome page
J M Tsutsui, F C. Lario, D R Fernandes, I Kowatsch, J C Sbano, J A Franchini Ramires, and W Mathias Jr
Safety and cardiac chronotropic responsiveness to the early injection of atropine during dobutamine stress echocardiography in the elderly
Heart, December 1, 2005; 91(12): 1563 - 1567.
[Abstract] [Full Text] [PDF]

Home page
 J. Gerontol. A Biol. Sci. Med. Sci.Home page
E. Biagini, A. Elhendy, A. F. L. Schinkel, V. Rizzello, J. J. Bax, F. B. Sozzi, M. D. Kertai, R. T. van Domburg, B. J. Krenning, A. Branzi, et al.
Long-Term Prediction of Mortality in Elderly Persons by Dobutamine Stress Echocardiography
J. Gerontol. A Biol. Sci. Med. Sci., October 1, 2005; 60(10): 1333 - 1338.
[Abstract] [Full Text] [PDF]

Home page
 JNMHome page
A. F.L. Schinkel, A. Elhendy, E. Biagini, R. T. van Domburg, R. Valkema, V. Rizello, C. Pedone, M. Simoons, J. J. Bax, and D. Poldermans
Prognostic Stratification Using Dobutamine Stress 99mTc-Tetrofosmin Myocardial Perfusion SPECT in Elderly Patients Unable to Perform Exercise Testing
J. Nucl. Med., January 1, 2005; 46(1): 12 - 18.
[Abstract] [Full Text] [PDF]

Home page
 JNMHome page
A. Elhendy, J. J. Bax, and D. Poldermans
Dobutamine Stress Myocardial Perfusion Imaging in Coronary Artery Disease
J. Nucl. Med., December 1, 2002; 43(12): 1634 - 1646.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF) Free
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Article Archive
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via ISI Web of Science (14)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Elhendy, A.
Right arrow Articles by Roelandt, J. R. T. C.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Elhendy, A.
Right arrow Articles by Roelandt, J. R. T. C.

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS