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The patent internal thoracic artery graft (ITAG) usually has a diastolic fraction (DF)50% of the flow. The functional assessment can be evaluated by the coronary reserve index (CRI).The objective was to evaluate the patency and functional status of the ITAG through echocardiography and Doppler.Data from sixty-six patients who underwent dobutamine-stress echocardiography (DSE) were prospectively collected and analyzed. Group I (GI) had 49 ITAG without stenosis, Group II (GII), 10 ITAG with significant stenosis (50% and100%) and Group III (GIII) had 7 ITAG with total occlusion. Diameters and Doppler spectrums from the ITAG at rest and during DSE were evaluated.Considering patency a DF50%, it was observed in 49 ITAG (GI= 40, GII= 8 and GIII= 1) at rest and in 61 ITAG (GI=49, GII=10 and GIII=2) during DSE. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were respectively, 81%, 86%, 98%, 35% and 82%, and 100%, at rest and 71%, 97%, 100% and 97% in the DSE. The ITAG with DF50% at rest were patent and the ones with DF50% in the DSE presented total occlusion. Considering a CRI1.8 for a good functional status, it was observed in 42 ITAG (39 from GI, 2 from GII and 1 from GIII), determining sensitivity=79%, specificity=85.7%, PPV=94%, NPV=59% and accuracy= 80.9%. The CRI in GI was higher (p= 0.02) than in GII or GIII.In our study, the non-invasive assessment of the ITAG was effective to verify the patency and the functional status.

To assess the feasibility and safety of dobutamine-atropine stress echocardiography (DASE) in octogenarians.We evaluated 5,467 DASE which were distributed in two groups: group I (GI) with 203 DASE performed in octogenarians, and group II (GII), the control group, with 5,264 DASE. The mean age of GI and GII was 83 +/- 3 (80-95) and 59 +/- 11 (17-79) years, respectively. DASE parameters that were prospectively collected, were compared and analyzed.The percentage of patients that achieved maximum heart rate was 63.5% in GI and 41% in GII (p0.001), and GI patients required less atropine compared to GII (GI = 47%, GII = 78%, p0.001). The presence of chest pain (GI = 13%, GII = 15.6%, p = 0.429) and DASE positive for myocardial ischemia (GI = 20.7%, GII = 16.9%, p = 0.296) were not statistically different between the two groups. However, concomitant positive DASE and absence of chest pain (GI = 17%, GII = 11%, p = 0.029) was higher in GI. The incidence of premature beats in GI was higher than in GII (GI = 47.8%, GII = 27.6%, p0.001), and there were more supraventricular tachyarrhythmias (ST) in GI than in GII (GI = 5.9%, GII = 1.9%, p = 0.001). Out of 11 ST that happened in GI, 9 reverted spontaneously. There weren't either deaths or acute myocardial infarction. Ventricular fibrillation only happened in GII (2 cases, 0.03%).In the present study, octogenarians achieved maximum heart rate more frequently despite the lesser amount of atropine that they required for DASE completion. Moreover, in this elderly population, there was a higher correlation between positive DASE and absence of chest pain. Although octogenarians did present more heart rhythm disturbs, they usually resolved spontaneously. In our study, DASE proved to be feasible and safe in octogenarians.

OBJETIVO: Verificar a exeqüibilidade e segurança do ecocardiograma sob estresse com dobutamina e atropina (EED) em octogenários. MÉTODOS: Avaliaram-se 5.467 EED, distribuídos entre grupo dos octogenários (GI=203) e grupo controle (GII=5.264). A idade média no GI=83±3 (80-95) e no GII=59±11 (17-79) anos. Os parâmetros resultantes do EED, coletados prospectivamente, foram comparados e analisados. RESULTADOS: O percentual de pacientes que atingiram freqüência cardíaca máxima foi em GI=63,5% e GII=41% (GI vs. GII; p