LONG-TERM PROGNOSTIC-SIGNIFICANCE OF DOBUTAMINE ECHOCARDIOGRAPHY IN PATIENTS WITH SUSPECTED CORONARY-ARTERY DISEASE - RESULTS OF A 5-YEAR FOLLOW-UP-STUDY

Citation
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
Citations number
19
Categorie Soggetti
Cardiac & Cardiovascular System
ISSN journal
07351097
Volume
29
Issue
5
Year of publication
1997
Pages
969 - 973
Database
ISI
SICI code
0735-1097(1997)29:5<969:LPODEI>2.0.ZU;2-I
Abstract
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.