Enhanced sensitivity for detection of coronary artery disease by addition of atropine to dipyridamole echocardiography

Eur Heart J. 1993 Sep;14(9):1216-22. doi: 10.1093/eurheartj/14.9.1216.


Dipyridamole echocardiography test (DET) has gained acceptance due to its safety, feasibility, diagnostic accuracy and prognostic power. The main limitation of the test is a less than ideal sensitivity in some patient subsets, such as those with limited coronary artery disease. Atropine with dipyridamole might theoretically combine to become a synergistic ischaemic stress test, by increasing myocardial oxygen demand through chronotropic stress and by reducing flow supply through a shortening of the diastolic interval under maximal coronary vasodilation. The aim of this study was to assess the effects of the addition of atropine to DET. Three hundred and twenty-one patients (age = 58 +/- 9 years), referred for testing in the echo lab, were initially studied by DET. Of these, 151 were stopped during or within the 2 min following dipyridamole infusion because of achievement of a predetermined end-point: obvious echocardiographic positivity (n = 137), severe chest pain (n = 3), diagnostic ST segment changes (n = 7) or limited side effects (n = 4). In another three cases, atropine was not given due to a history of glaucoma or severe prostatic hypertrophy. In the remaining 167 patients with a negative DET test, atropine (0.25 mg intravenously, repeated every min up to a maximum of 1 mg, if necessary) was added, starting 3 min after the end of the dipyridamole infusion. The dipyridamole-atropine echo test (DETA) was positive in 32 and negative in 135 patients, and no major side effects occurred in any patient.(ABSTRACT TRUNCATED AT 250 WORDS)

MeSH terms

  • Adult
  • Aged
  • Atropine* / pharmacology
  • Blood Pressure / drug effects
  • Coronary Angiography
  • Coronary Disease / diagnostic imaging*
  • Coronary Disease / physiopathology
  • Dipyridamole* / pharmacology
  • Echocardiography / methods*
  • Female
  • Heart Rate / drug effects
  • Humans
  • Male
  • Middle Aged
  • Sensitivity and Specificity


  • Dipyridamole
  • Atropine