Gabapentinoids therapy is associated with higher doses of atropine and dobutamine in stress echocardiography
Ortiz D, Gotz A, Mahlum D, Ammar KA, Port SC. Gabapentinoids Therapy Is Associated With Higher Doses Of Atropine And Dobutamine In Stress Echocardiography. Journal of the American College of Cardiology. 2017;69(11):1636. doi:10.1016/s0735-1097(17)35025-8.
BACKGROUND: Anecdotal observation by a stress technician suggested that patients on gabapentinoids required longer protocols to achieve the target heart rate (HR) during stress echocardiography. In addition, recent randomized clinical trials have shown attenuation of reflex tachycardia and hypertension in patients undergoing direct laryngoscopy when premedicated with gabapentin. The aim of this study was to assess the effect of gabapentinoid therapy on dobutamine-atropine stress echocardiography.
METHODS: Consecutive patients undergoing dobutamine-atropine (maximum dose: 40 μg/kg/min of dobutamine) stress echocardiography in an outpatient laboratory were retrospectively studied. Patients on beta-blockers, non-dihydropyridine calcium channel blockers, or with aborted stress protocols were excluded. Thirty-one patients on gabapentin (n=25) or pregabalin (n=6) where identified and compared with 67 controls.
RESULTS: The study and control groups were similar in mean age (59.8±11.4 years vs 63.9±12.2 years, p=0.06), percentage male (38.7% vs 35.8%, p=0.8), and baseline resting HR (75.3±11.2 beats per minute [BPM] vs 76.2±13.3 BPM, p=0.4). The study and control groups had similar changes in HR (72.9 vs 64.2, p=0.1), systolic blood pressure (10.8 vs 13.7, p=0.3) and diastolic blood pressure (-0.3 vs 3.8 mmHg, p=0.2), and dobutamine infusion duration (12:05 vs 11:16, p=0.1) required to reach 85% of the maximum predicted HR. Patients on gabapentinoids, however, more often required the maximum dobutamine dose (67.7% vs 40.3%, odds ratio=3.1, p=0.011) and atropine (35.5% vs 13.4%, odds ratio=3.5, p=0.012) to reach the target HR. This difference persisted after adjusting for age.
CONCLUSIONS: Patients on gabapentinoids are more than three times more likely to receive atropine and >40 mcg/Kg/m peak dobutamine infusion dose during stress echocardiography. This novel observation deepens our understanding of this commonly used drug in cardiac patients.