STRESS ECHOCARDIOGRAPHY IN ELDERLY PATIENTS WITH CORONARY-ARTERY DISEASE - APPLICABILITY, SAFETY AND PROGNOSTIC VALUE OF DOBUTAMINE AND ADENOSINE ECHOCARDIOGRAPHY IN ELDERLY PATIENTS

Objectives. our aim was to determine the applicability, safety and pro gnostic value of adenosine and dobutamine stress echocardiography in p atients greater than or equal to 70 Sears old. Background. These tests are sometimes mandatory because of difficulties and inaccuracies in i nterpreting traditional electrocardiographic stress tests, Furthermore , if these tests could be used to avoid coronary arteriography and car diac catheterization, they would become essential in the care of the e lderly, whose numbers are increasing. Methods. We performed coronary a rteriography and dobutamine and adenosine stress echocardiographic tes ts in 120 patients (72 men) greater than or equal to 70 years old who entered the hospital because of chest pain and had known or suspected coronary artery disease. The stress tests were performed on separate d ays, within 2 weeks of coronary arteriography, Both the arteriograms a nd the echocardiograms were analyzed by two experts who had no knowled ge of the patients' other data or the other interpreter's report, Test s were judged to have positive or negative results, and the patients w ere followed up for the development of cardiac events, Univariate and multivariate analyses and other statistical modalities were applied fo r comparisons. Results. Documented coronary artery disease was found i n 89 patients. During the 14 +/- 7 months of follow-up, cardiac events developed in 50 patients, including 3 (7.9%) of 38 patients with nega tive dobutamine and 12 (20.7%) of 58 patients with negative adenosine test results. Demonstration of any abnormality on stress echocardiogra phy was an independent factor for cardiac events, both For dobutamine (relative risk 7.3) and fur adenosine (relative risk 3.0). Both cessat ion of dobutamine or adenosine tests and diagnosis of disease in two o r more coronary vessels were also independent predictors. ST segment d epression greater than or equal to 1 mm was related to future events o nly with the dobutamine test. Conclusions. These echocardiographic str ess tests proved safe and web tolerated, They successfully stratified this cohort of elderly patients with coronary artery disease to low or high risk subgroups for subsequent cardiac events.