Prognostic value of dobutamine stress echocardiography in patients referred because of suspected coronary artery disease
Department of Medicine, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio 44109, USA. The American Journal of Cardiology
(Impact Factor: 3.28).
11/1995; 76(12):887-91. DOI: 10.1016/S0002-9149(99)80255-0
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)
Available from: Rune Haaverstad
- "Stress echocardiography is the combination of 2D echocardiography with a physical, pharmacological or electrical stress [15,16]. Stress echocardiography has been regarded as an important tool in the field of noninvasive diagnosis of coronary artery disease [17,18] and in patients with suspected severe aortic stenosis with low aortic gradients secondary to low cardiac output [19,20]. "
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ABSTRACT: 112 patients who received small and medium sized St. Jude Regent heart valves (19-25 mm) at 7 Scandinavian centers were studied between January 2003 and February 2005 to obtain non-invasive data regarding the hemodynamic performance at rest and during Dobutamine stress echocardiography (DSE) testing one year after surgery.
46 woman and 66 men, aged 61.8 ± 9.7 (18-75) years, were operated on for aortic regurgitation (17), stenosis (65), or mixed dysfunction (30). Valve sizes were 19 mm (6), 21 mm (33), 23 mm (41), 25 mm (30). Two patients receiving size 27 valves were excluded from the hemodynamic evaluation. Pledgets were used in 100 patients, everted mattress in 66 and simple interrupted sutures in 21. Valve orientation varied and was dependent on the surgeons' choice. 34 patients (30.4%) underwent concomitant coronary artery surgery.
There were two early deaths (1.8%) and three late deaths, one because of pancreatic cancer. Late events during follow-up were: non structural dysfunction (1), bleeding (2), thromboembolism (2). At one year follow up 93% of the patients were in NYHA classes 1-2 versus 47.8% preoperatively. Dobutamine stress echocardiography (DSE) was performed in a total of 66 and maximal peak stress was reached in 61 patients. During DSE testing, the following statistically significant changes took place: Heart rate increased by 73.0%, cardiac output by 85.5%, left ventriclular ejection fraction by 19.6%, and maximal mean prosthetic transvalvular gradient by 133.8%, whereas the effective orifice area index did not change. Left ventricular mass fell during one year from 215 ± 63 to 197 ± 62 g (p < 0.05).
The Dobutamine test induces a substantial stress, well suitable for echocardiographic assessment of prosthesis valve function and can be performed in the majority of the patients. The changes in pressure gradients add to the hemodynamic characteristics of the various valve sizes. In our patients the St. Jude Regent valve performed satisfactory at rest and under pharmacological stress situation.
Journal of Cardiothoracic Surgery 12/2011; 6(1):163. DOI:10.1186/1749-8090-6-163 · 1.03 Impact Factor
Available from: Linda D Gillam
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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 · 2.94 Impact Factor
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