ROLE OF DOBUTAMINE STRESS ECHOCARDIOGRAPHY IN PREDICTING OUTCOME OF 860 PATIENTS WITH KNOWN OR SUSPECTED CORONARY-ARTERY DISEASE

Background-Increasingly, dobutamine stress echocardiography has been u sed for detection of coronary artery disease. Less information exists regarding the incremental prognostic value of the test, including semi quantitative wall scoring, compared with clinical and rest echocardiog raphic variables. Methods and Results-Follow-up information was obtain ed from 860 patients who underwent dobutamine stress echocardiography over a 2-year period. To determine the value of dobutamine stress echo cardiography in predicting cardiac events, including cardiac death and myocardial infarction, clinical and rest and stress echocardiographic data were considered in a stepwise Cox multivariate regression model. During follow-up of up to 52 months, 72 patients underwent coronary r evascularization before any cardiac event and were censored. Eighty-si x patients had cardiac events, including nonfatal myocardial infarctio n in 36 and cardiac death in 50. In a multivariate model, a history of congestive heart failure, the percentage of abnormal segments at peak stress, and an abnormal left ventricular end-systolic volume response to stress were independent predictors cf cardiac events. The model th at best predicted subsequent cardiac events included clinical and stre ss echocardiographic data. Conclusions-Dobutamine stress echocardiogra phy with semiquantitative segmental wall scoring provides important in cremental information in predicting subsequent cardiac events.