OBJECTIVE: To investigate the functional significance of chronotropic incompetence during dobutamine stress echocardiography. PATIENTS AND METHODS: The functional significance of chronotropic incompetence was evaluated during dobutamine stress echocardiography in 512 patients without beta blocker treatment who underwent dobutamine stress echocardiography (up to 40 microg/kg/min) and completed the protocol or reached the target heart rate. Mean (SD) age was 60 (12) years (313 men, 199 women). Chronotropic incompetence was defined as failure to achieve 85% of the maximum exercise heart rate predicted for age and sex (220 - age in men; 200 - age in women) at maximum dobutamine dose. RESULTS: Chronotropic incompetence occurred in 196 patients (38%). Affected patients were significantly younger, more likely to be men (both p << 0.001) and smokers (p < 0.05), had a higher prevalence of previous myocardial infarction (p < 0.005) and resting wall motion abnormalities (p < 0. 05), and had a lower resting heart rate (p << 0.001) and systolic blood pressure (p << 0.001) than patients without chronotropic incompetence, but there was no difference in the overall prevalence of ischaemia and significant coronary artery disease. By multivariate analysis, independent predictors of chronotropic incompetence were a lower resting heart rate (p << 0.001), younger age (p << 0.001), and male sex (p << 0.001). CONCLUSIONS: The relations among sex, age, and chronotropic incompetence show the need to titrate the dobutamine dose using specific data based on age and sex related heart rate responses to dobutamine rather than to an exercise stress test. Obtaining specific heart rate criteria is necessary to determine whether chronotropic incompetence represents a real failure to achieve a normal response or is the result of applying an inappropriate gold standard.
OBJECTIVE: To investigate the functional significance of chronotropic incompetence during dobutamine stress echocardiography. PATIENTS AND METHODS: The functional significance of chronotropic incompetence was evaluated during dobutamine stress echocardiography in 512 patients without beta blocker treatment who underwent dobutamine stress echocardiography (up to 40 microg/kg/min) and completed the protocol or reached the target heart rate. Mean (SD) age was 60 (12) years (313 men, 199 women). Chronotropic incompetence was defined as failure to achieve 85% of the maximum exercise heart rate predicted for age and sex (220 - age in men; 200 - age in women) at maximum dobutamine dose. RESULTS: Chronotropic incompetence occurred in 196 patients (38%). Affected patients were significantly younger, more likely to be men (both p << 0.001) and smokers (p < 0.05), had a higher prevalence of previous myocardial infarction (p < 0.005) and resting wall motion abnormalities (p < 0. 05), and had a lower resting heart rate (p << 0.001) and systolic blood pressure (p << 0.001) than patients without chronotropic incompetence, but there was no difference in the overall prevalence of ischaemia and significant coronary artery disease. By multivariate analysis, independent predictors of chronotropic incompetence were a lower resting heart rate (p << 0.001), younger age (p << 0.001), and male sex (p << 0.001). CONCLUSIONS: The relations among sex, age, and chronotropic incompetence show the need to titrate the dobutamine dose using specific data based on age and sex related heart rate responses to dobutamine rather than to an exercise stress test. Obtaining specific heart rate criteria is necessary to determine whether chronotropic incompetence represents a real failure to achieve a normal response or is the result of applying an inappropriate gold standard.
Authors: A Elhendy; M L Geleijnse; J R Roelandt; J H Cornel; R T van Domburg; M El-Refaee; M M Ibrahim; G M El-Said; P M Fioretti Journal: Am J Cardiol Date: 1996-06-01 Impact factor: 2.778
Authors: J H Cornel; A H Balk; E Boersma; A P Maat; A Elhendy; M Arnese; A Salustri; J R Roelandt; P M Fioretti Journal: J Am Soc Echocardiogr Date: 1996 Jan-Feb Impact factor: 5.251
Authors: A Elhendy; J H Cornel; J R Roelandt; R T van Domburg; P R Nierop; M L Geleÿnse; G M El-Said; P M Fioretti Journal: Am J Cardiol Date: 1996-05-01 Impact factor: 2.778
Authors: D Poldermans; E Boersma; P M Fioretti; H van Urk; F Boomsma; A J Man in 't Veld Journal: J Am Coll Cardiol Date: 1995-04 Impact factor: 24.094
Authors: A Elhendy; M L Geleijnse; J R Roelandt; R T van Domburg; F J TenCate; J H Cornel; A E Reijs; G M el-Said; P M Fioretti Journal: J Am Coll Cardiol Date: 1996-02 Impact factor: 24.094
Authors: Dirkjan Kuijpers; Paul R M van Dijkman; Caroline H C Janssen; Rozemarijn Vliegenthart; Felix Zijlstra; Matthijs Oudkerk Journal: Eur Radiol Date: 2004-07-24 Impact factor: 5.315
Authors: Andrea De Lorenzo; James Foerster; Maria G Sciammarella; Cathy Suey; Sean W Hayes; John D Friedman; Daniel S Berman Journal: J Nucl Cardiol Date: 2003 Jan-Feb Impact factor: 5.952