Prognostic value of negative transesophageal dobutamine stress echocardiography in men at high risk for coronary artery disease

Recently published reviews have called into question the sensitvity of tran sthoracic stress echocardiography to predict cardiac events, especially whe n the test is negative, compared with myocardial perfusion imaging studies. To our knowledge there are a lack of data assessing the prognostic value o f transesophageal echocardiography-dobutamine stress echocardiography (TEE- DSE) in predicting cardiac events. Because TEE-DSE has been reported to be highly accurate for detecting ischemia in patients with suspected coronary artery disease, we tested the hypothesis that a negative TEE-DSE can identi fy a low-risk group in a population with a high likelihood of coronary arte ry disease. Between October 1996 and December 1997, 46 high-risk patients w ith negative TEE-DSE were identified. Annualized pretest risk for all cardi ac events using the Framingham model was 4% based on risk factors. Mean age was 64 years. Mean follow-up time was 16.2 months. There were no cardiac d eaths. There were 6 soft and 1 hard cardiac event. The annualized combined ischemic cardiac event rate was 3.8%, and for hard cardiac events it was 1. 1%. By Kaplan-Meier analysis, 97% of the population remained free of any is chemic event at the end of 1 year and 93% were free at 22 months. We conclu de that optimal image quality and enhanced endocardial definition for asses sing wall motion changes with TEE translates into better prognostication an d approaches that of myocardial perfusion imaging for negative studies. Adv ances in ultrasound medicine such as contrast enhancement of myocardial def inition, which improve diagnostic accuracy of DSE, should translate into be tter prognostication. (C) 2000 by Excerpta Medica, Inc.