الفهرس 
MYOCARDIAL ISCHEMIAOnly 14 pages are availabe for public view
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Abstract
Coronary artery disease (CAD) is highly prevalent and is considered the leading cause of cardiac morbidity and mortality particularly in the elderly population (Chaitman BR, 1986).
Recent modification in DSE protocol include earlier injection of atropine in elderly patients who are subjected to pharmacological stress testing for detection of myocardial ischemia (Lessick et al., 2000).
Early injection of atropine is a safe and effective strategy during DSE, and this protocol improved the diagnostic accuracy for detecting CAD particularly in the risky population of elderly patients. (Jeane et al., 2004).
The purpose of this study is to evaluate the safety and efficacy of the early injection of atropine during DSE in comparison with the conventional DSE protocol for detection of coronary artery diseases in elderly patients.
Our study included 100 patients above sixty years old. The patients were divided into two groups, group I included 50 patients, received EA-DSE. Group II included 50 patients, received DASE.
Dobutamine stress echocardiography was done to all patients. A graded dobutamine infusion were started at resting stage and at 5ug/kg/min then at 10,20,30 up to 40 ug/kg/min in 3 min stages. Atropine was injected according to each protocols. For DASE atropine was injected with 40ug/kg/min stage if patients did not achieve 85% of predicted maximum heart rate. For EA-DSE, atropine was injected earlier with 20 or 30 ug/kg/min according to heart rate.
Images were acquired at rest, low dose, peak stress and recovery phases and displayed side by side in a quad screen format and were analyzed. The results of our study in each protocol were compared to each other and with pervious studies reported before addressing the same issue.
In our study, the mean of the maximum doses of dobutamine used were significantly lower in patients of GI in comparison to patients of GII. On the other hand, no statistically significant difference between both groups as regards atropine doses.
The test duration in our study was significantly reduced during EA-DSE protocol(11.5+1.3 min for GI vs 14.3+3.5 min for GII p<0.01)., minimizing the patients’ exposure to dobutamine infusion and its complication.
The side effects that were recorded in our study e.g arrhythmias, hypotension, MI and general side effects, were significantly higher in group II, hence limiting its efficacy for predicting myocardial ischemia.
Finally, we concluded that early injection of atropine during DSE is a safe method for detection of myocardial ischemia in the elderly patients but its efficacy need a gold standard to be confirmed.