PROGNOSTIC VALUE OF LEFT-VENTRICULAR VOLUME RESPONSE DURING DOBUTAMINE STRESS ECHOCARDIOGRAPHY

Aims An abnormal left ventricular volume response during dobutamine ec hocardiography identified patients with severe coronary artery disease . The aim of the study was to assess the prognostic value of left vent ricular volume changes during dobutamine stress echocardiography in 13 6 patients, Methods and results Endpoints were defined as spontaneous cardiac events at follow-up. Left ventricular end-diastolic and end-sy stolic volume changes (abnormal response: <10% and <20% decrease, resp ectively) were compared with other clinical and stress test variables. During 18+/-7 months of follow-up, 31 cardiac events occurred: 12 har d events (cardiac death [n=6], myocardial infarction [n=6]) and 19 sof t events (unstable angina [n=16], congestive heart failure [n=3]). End -diastolic volume response (P=0.006), diabetes (P=0.008), inducible wa ll motion abnormalities (P=0.024), end-systolic volume response (P=0.0 39) and inducible angina (P=0.038) were related to a greater likelihoo d of cardiac events. The Cox regression analysis revealed end-diastoli c volume response (odds ratio: 30; CI 1.44-6.32) and diabetes (odds ra tio: 2.7; CI 1.28-5.69) to be independent predictors of spontaneous ca rdiac events. Diabetes (odds ratio: 4.0; CI 1.26-12.80) and <40% basel ine ejection fraction (odds ratio: 2.21; CI 1.14-4.29) were independen t predictors of hard events. Conclusion An abnormal end-diastolic volu me response during dobutamine stress echocardiography identifies patie nts with an unfavourable outcome; they should be considered for more a ccurate prognostic stratification.