VALUE OF DOBUTAMINE STRESS ECHOCARDIOGRAPHY IN DETERMINING THE PROGNOSIS PATIENTS WITH KNOWN OR SUSPECTED CORONARY-ARTERY DISEASE

Although the accuracy of dobutamine stress echo (DSE) for detecting co ronary artery disease (CAD) has been established, its role in determin ing prognosis is less well defined, The purpose of this study was to e valuate the prognostic significance of DSE in patients with known or s uspected CAB. Follow-up was obtained on 291 patients an average of 15 months after clinically indicated DSE. Studies were stratified with re spect to resting and inducible wall motion abnormalities into 1 of 4 r esponses: normal, ischemic, fixed, and mixed. Hard end points of nonfa tal myocardial infarction and cardiac death were tabulated for outcome . Statistically significant differences in the incidence of hard cardi ac end points were noted for 2 of 4 DSE responses. A normal DSE was as sociated with a statistically lower likelihood of a hard cardiac event than was a DSE demonstrating resting or inducible abnormalities (p = 0.001). DSE with a mixed response (resting abnormality with additional inducible ischemia) was associated with a higher likelihood of cardia c events by multivariate analysis (p = 0.003). By multiple logistic re gression analysis of dobutamine response, age, and cardiac risk factor s, only a mixed response on DSE was independently associated with the occurrence of a hard cardiac event in the follow-up period. In additio n, left ventricular dysfunction on the resting echocardiogram was asso ciated with a worse prognosis in patients with major noncardiac diseas e, We conclude that dobutamine response is are independent predictor o f cardiac events compared with traditional risk factor analysis and th at DSE can identify high- and low-risk subsets of patients with known or suspected CAD.