PROGNOSTIC VALUE OF DOBUTAMINE STRESS ECHOCARDIOGRAPHY IN PATIENTS REFERRED BECAUSE OF SUSPECTED CORONARY-ARTERY DISEASE

To determine whether dobutamine stress echocardiography (DSE) provides prognostic information beyond that available from routine clinical da ta, we reviewed the outcome of 210 consecutive patients referred for D SE to evaluate chest pain, perioperative risk, and myocardial viabilit y. Dobutamine was infused in increments of 10 mu g/kg/min in 5-minute stages to a maximum of 40 mu g/kg/min. The dobutamine stress echocardi ogram was considered abnormal only if dobutamine induced a new wall mo tion abnormality as determined by review of the digitized echocardiogr aphic Images In a quad screen format and on videotape. Thirty percent of tests were abnormal. An abnormal test was more common (p less than or equal to 0.02) in men and patients with angina pectoris, in patient s taking nitrate therapy, or those with prior myocardial infarction or abnormal left ventricular wall motion at rest. Twenty-two deaths, 17 of which were cardiac, occurred over a median follow-up of 240 days (r ange 30 to 760). Sixteen cardiac deaths occurred in the 63 patients wi th versus 1 cardiac death among the 147 without a new wall motion abno rmality (p less than or equal to 0.0001). Other variables associated w ith cardiac death (p less than or equal to 0.05) were age >65 years, n itrate therapy, ventricular ectopy during DSE, suspected angina pector is, and hospitalization at the time of DSE. When cardiac death, myocar dial infarction, and revascularization procedures were all considered as adverse outcomes, a new wall motion abnormality continued to be the most powerful predictor of an adverse cardiac event. We conclude that DSE provides greater prognostic information than that available from clinical data in a population known or suspected to have coronary arte ry disease and unable to exercise.