LONG-TERM PROGNOSTIC-SIGNIFICANCE OF DOBUTAMINE ECHOCARDIOGRAPHY IN PATIENTS WITH SUSPECTED CORONARY-ARTERY DISEASE - RESULTS OF A 5-YEAR FOLLOW-UP-STUDY
Eh. Steinberg et al., LONG-TERM PROGNOSTIC-SIGNIFICANCE OF DOBUTAMINE ECHOCARDIOGRAPHY IN PATIENTS WITH SUSPECTED CORONARY-ARTERY DISEASE - RESULTS OF A 5-YEAR FOLLOW-UP-STUDY, Journal of the American College of Cardiology, 29(5), 1997, pp. 969-973
Objectives. This study sought to assess the long-term prognostic utili
ty of dobutamine stress echocardiography in predicting fatal and nonfa
tal cardiac events. Background Although dobutamine stress echocardiogr
aphy has improved sensitivity and specificity for detection of coronar
y artery disease, little is known of its predictive value for long-ter
m cardiac events. Therefore, we followed up 120 consecutive patients w
ho underwent dobutamine echocardiography for suspected coronary diseas
e from March 1989 to August 1991. Methods. All patients presenting for
coronary angiography for chest pain mere eligible for recruitment. Fo
llow-up was 100% complete at 5 years (range 3.0 to 6.1). Cardiac event
s were defined as cardiac death or nonfatal myocardial infarction or t
he need for coronary revascularization (coronary angioplasty or bypass
surgery). Results. Positive (n = 78) and negative (n = 42) dobutamine
test groups differed in their rates of coronary artery bypass graft s
urgery (37.2% vs. 9.5%, p < 0.001, respectively) and mortality. Of 26
total deaths, 22 occurred in the group with positive dobutamine test r
esults (28% vs. 9.5%, p < 0.018); all 7 cardiac deaths occurred in thi
s group as well (9% vs. O%, p < 0.045). By multivariate regression ana
lysis, positive results on dobutamine echocardiography remained indepe
ndently predictive of future cardiac death after left ventricular ejec
tion fraction and other clinical variables were accounted for. Conclus
ions. A positive finding on dobutamine echocardiography is an independ
ent predictor of long-term cardiac mortality, whereas a negative findi
ng confers a significantly reduced likelihood of cardiac death as much
as 5 years from initial testing. We conclude that dobutamine stress e
chocardiography can be used to predict which patients with suspected c
oronary artery disease are at low risk for cardiac death and do not re
quire concurrent nuclear or invasive testing.