Functional and prognostic significance of silent ischemia during dobutamine stress echocardiography in the elderly

Background The functional and prognostic significance of silent ischemia re lative to symptomatic ischemia during non-invasive testing remains controve rsial. Design The aim of this prospective study was to assess whether the presence of dobutamine-induced silent ischemia was associated with the amount of my ocardial ischemic burden and to determine the prognostic significance of pa inless ischemia in elderly people with stable coronary artery disease. Methods A cohort of 289 patients greater than or equal to 70 years of age w ith positive dobutamine stress echocardiography result and significant coro nary artery disease proven by coronary arteriography, were followed up duri ng a 35 +/- 13 month period for the development of cardiac events. Results The prevalence of silent ischemia during dobutamine infusion was 63 %. Patients with painful ischemia were more likely to have lower peak heart rate (P < 0.01) and showed ST segment depression more frequently during th e dobutamine stress test than did patients with painless ischemia (52 versu s 31%, P < 0.05), There was no significant difference between the patients with and without angina according to wall motion score index at rest (1.35 +/- 0.29 versus 1.32 +/- 0.37) and at peak stress (1.61 +/- 0.35 versus 1.5 8 +/- 0.44), stress-rest wall motion index difference (0.27 +/- 0.09 versus 0.25 +/- 0.08), the presence of dyskinesia at peak stress (36 versus 31%), the number of segments with regional greater than or equal to2 point chang e from rest to peak stress (38 versus 29%) and the decrease of left ventric ular end systolic volume at peak stress (89 versus 86%), During the follow- up period a total of 269 patients developed 153 (57%) cardiac events: 15 ca rdiac deaths, 19 non-fatal myocardial infarctions, 119 episodes of unstable angina. No significant difference in cardiac mortality and in total cardia c event rate was observed between patients with or without angina (6 versus 5% and 60 versus 55%, respectively). Conclusions Our data demonstrate that the magnitude of myocardial dysfuncti on assessed by dobutamine stress echocardiography is comparable in elderly patients with or without anginal chest pain. The presence of painful ischem ia is not accompanied by an increased risk for subsequent cardiac events in this cohort of patients. Coron Artery Dis 12:499-506 (C) 2001 Lippincott W illiams & Wilkins.