Atropine as an adjunct to supine bicycle stress echocardiography: an alternative strategy to achieve target heart rate or rate pressure product.

AIMS: To investigate the use of atropine to achieve target heart rate (THR) and rate pressure product (RPP) during supine bicycle exercise stress echocardiography (SBESE) to increase the number of diagnostic stress tests. METHODS AND RESULTS: Forty-four patients that were unable to achieve THR or RPP during SBESE performed to evaluate ischaemia were given 0.4-1.2 mg of atropine to augment THR and RPP. After atropine (0.7 ± 0.3 mg) the maximum heart rate (HR) achieved was 133 (± 16) bpm, mean THR was 82% (± 8%), and average RPP was 22 716 (± 4915) b/min × mmHg. Of the patients with a non-diagnostic SBESE, with the use of atropine 80% of those patients achieved a diagnostic test. There were no major adverse affects from the administration of atropine. CONCLUSION: The use of atropine to augment the HR or RPP during SBESE (i) is safe; (ii) enables the assessment of ischaemia at peak effort; and (iii) allows assessment of exercise haemodynamics in patients with sub-maximal exercise capacity and chronotropic incompetence.

Aortopathy is prevalent in relatives of bicuspid aortic valve patients.

OBJECTIVES: This study aimed to determine the prevalence of dilation and abnormal elastic properties of aortic root in first-degree relatives (FDRs) of bicuspid aortic valve (BAV) patients. BACKGROUND: Evidence indicates that BAV is a genetic disorder. Although FDRs of affected individuals have an increased prevalence of BAV, their risk of aortic root abnormalities is unknown. METHODS: We studied dimensions as well as the elastic properties of the ascending aorta in 48 FDRs with morphologically normal tricuspid aortic valves, 54 BAV patients, and 45 control subjects using 2-dimensional echocardiography. RESULTS: The prevalence of aortic root dilation was 32% in FDRs and 53% in BAV patients, whereas all control subjects showed normal aortic dimensions (p < 0.001). The FDRs and BAVs had significantly lower aortic distensibility (1.7 +/- 1.4 x 10(-3) mm Hg and 1.4 +/- 2.0 x 10(-3) mm Hg vs. 2.5 +/- 1.6 x 10(-3) mm Hg, p < 0.001) and greater aortic stiffness index (26.7 +/- 25.8 and 55.9 +/- 76.8 vs. 18.7 +/- 40.1, p = 0.001) compared with control subjects. This difference remained significant in subjects without aortic root dilation or hypertension (p = 0.002 and p = 0.004, respectively). CONCLUSIONS: The aortic root is functionally abnormal and dilation is common (32%) in first-degree relatives of patients with BAV. Screening of FDRs by transthoracic 2-dimensional echocardiography should be considered for detection of aortic valve malformation and dilated ascending aorta.