Prognostic value of dobutamine stress echocardiography in patients referred because of suspected coronary artery disease.
ABSTRACT To determine whether dobutamine stress echocardiography (DSE) provides prognostic information beyond that available from routine clinical data, we reviewed the outcome of 210 consecutive patients referred for DSE to evaluate chest pain, perioperative risk, and myocardial viability. Dobutamine was infused in increments of 10 micrograms/kg/min in 5-minute stages to a maximum of 40 micrograms/kg/min. The dobutamine stress echocardiogram was considered abnormal only if dobutamine induced a new wall motion abnormality as determined by review of the digitized echocardiographic images in a quad screen format and on videotape. Thirty percent of tests were abnormal. An abnormal test was more common (p < or = 0.02) in men and patients with angina pectoris, in patients taking nitrate therapy, or those with prior myocardial infarction or abnormal left ventricular wall motion at rest. Twenty-two deaths, 17 of which were cardiac, occurred over a median follow-up of 240 days (range 30 to 760). Sixteen cardiac deaths occurred in the 63 patients with versus 1 cardiac death among the 147 without a new wall motion abnormality (p < or = 0.0001). Other variables associated with cardiac death (p < or = 0.05) were age > 65 years, nitrate therapy, ventricular ectopy during DSE, suspected angina pectoris, and hospitalization at the time of DSE. When cardiac death, myocardial infarction, and revascularization procedures were all considered as adverse outcomes, a new wall motion abnormality continued to be the most powerful predictor of an adverse cardiac event.(ABSTRACT TRUNCATED AT 250 WORDS)
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ABSTRACT: The unique contribution of the study by Candell-Riera et al in this issue of the Journal is the evaluation of the prognostic value of stress nuclear MPI and stress echocardiography in the same post-MI cohort. Importantly, it confirms the valuable information that stress nuclear MPI has to offer for management of post-MI patients and simultaneously underscores the limitations of stress echocardiography for the same application. Although the study has limitations, including its relatively small sample size, these observations are consistent with those of a large body of literature involving thousands of patients. Thus this study supports the use of stress nuclear MPI for the evaluation of the post-MI patient as part of an evidence-based clinical practice and provides further concern regarding the use of stress echocardiography as an alternative imaging modality in this setting. It should serve as a reminder that when it comes to evaluation of the patient with coronary heart disease, not all noninvasive tests are created equal.Journal of Nuclear Cardiology 03/2001; 8(2):215-8. DOI:10.1067/mnc.2001.112856 · 2.65 Impact Factor
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Article: Table Of Contents ACC/AHA Guidelines for the Clinical Application of Echocardiography A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography) Developed in Collaboration With the American Society of