Prognostic value of dobutamine stress echocardiography after an uncomplicated acute myocardial infarction

Background and purpose. The identification of patients at risk for future e vents after an infarction is mandatory. The aim of this study was to assess the prognostic value of dobutamine was to assess the prognostic value of d obutamine stress echocardiography after an uncomplicated myocardial infarct ion. Methods. One hundred and twenty five patients (mean age 65 +/- 11 years, ma les 82%) underwent dobutamine-echo within ten days after an uncomplicated m yocardial infarction. Four myocardial responses were identified: a) negativ e; b) sustained improvement of myocardial contractility; c) initial improve ment followed by worsening, and d) worsening at a distance or in the infarc ted zone. Results. Mean follow-up was 7.4 +/- 4.6 months. An adverse outcome occurred in 47 patients: non cardiac death in 3, cardiac death in 6, myocardial inf arction in 5, angina in 21, congestive heart failure in 2, and in 10 patien ts revascularization. Cox regression analysis showed that worsening of cont ractibility was the best predictor for adverse events (p < 0.0001, relative risk 2.8; 95% confidence interval: 1.7-4.5). Non-smoking and previous angi na were also predictors of adverse events (p = 0.003 and p = 0.04, respecti vely). Similar results were obtained after excluding the revascularized pat ients. Conclusions. Sustained improvement of contractility in the infarcted region is not a predictor of adverse events. Asynergy at a distance or in the inf arcted region during dobutamine echocardiography within ten days after an u ncomplicated myocardial infarction predicts adverse cardiac events during f ollow-up. Therefore, dobutamine echocardiography could be used for risk str atification after acute myocardial infarction.