Prognostic value of dobutamine-atropine stress echocardiography early after acute myocardial infarction. Echo Dobutamine International Cooperative (EDIC) Study

CNR, Institute of Clinical Physiology, Pisa, Italy.

OBJECTIVES: The aim of this multicenter, multinational, prospective, observational study was to assess the relative value of myocardial viability and induced ischemia early after uncomplicated myocardial infarction. BACKGROUND: Dobutamine-atropine stress echocardiography allows evaluation of rest function (at baseline), myocardial viability (at low dose) and residual ischemia (peak dose, up to 40 micrograms with atropine up to 1 mg) in one test. METHODS: Dobutamine-atropine stress echocardiography was performed 12 +/- 5 days (mean +/- SD) after a first uncomplicated acute myocardial infarction in 778 patients (677 men; mean age 58 +/- 10 years) with technically satisfactory rest echocardiographic study results. Patients were followed-up for 9 +/- 7 months. RESULTS: Dobutamine-atropine stress echocardiographic findings were positive for myocardial ischemia in 436 of patients (56%) and negative in 342 (44%). During follow-up, there were 14 cardiac-related deaths (1.8% of the total cohort), 24 (2.9%) nonfatal myocardial infarctions and 63 (8%) hospital readmissions for unstable angina. One hundred seventy-four patients (22%) underwent coronary revascularization (bypass surgery or coronary angioplasty). Spontaneous events occurred in 61 of 436 patients with positive and 40 of 342 patients with negative findings on dobutamine-atropine stress echocardiography (14% vs. 12%, p = 0.3). When only spontaneously occurring events were considered, the most important predictor was myocardial viability (chi-square 9.7). Using the Cox proportional hazards model, only the presence of myocardial viability (hazard ratio [HR] 2.0, p < 0.002) and age (HR 1.03, p < 0.001) were predictive of spontaneously occurring events. When only hard cardiac events were considered, age was the strongest predictor (chi-square 3.6, p = 0.056), followed by wall motion score index (WMSI) at peak dose (chi-square 3.3, p = 0.06) and remote ischemia (chi-square 2.25, p = 0.1). When cardiac death was considered, WMSI at peak dose was the best predictor (HR 9.2, p < 0.0001). CONCLUSIONS: During dobutamine stress, echocardiographic recognition of myocardial viability is more prognostically important than echocardiographic recognition of myocardial ischemia for predicting unstable angina, whereas WMSI at peak stress was the best predictor of cardiac-related death. Different events can be recognized with different efficiency by various stress echocardiographic variables.

This article has been cited by other articles:

				S A Mollema, G Nucifora, and J J Bax Prognostic value of echocardiography after acute myocardial infarction Heart, November 1, 2009; 95(21): 1732 - 1745. [Abstract] [Full Text] [PDF]

				B. Beleslin, M. Ostojic, A. Djordjevic-Dikic, V. Vukcevic, S. Stojkovic, M. Nedeljkovic, G. Stankovic, D. Orlic, N. Milic, J. Stepanovic, et al. The value of fractional and coronary flow reserve in predicting myocardial recovery in patients with previous myocardial infarction Eur. Heart J., November 1, 2008; 29(21): 2617 - 2624. [Abstract] [Full Text] [PDF]

				R. Sicari, P. Nihoyannopoulos, A. Evangelista, J. Kasprzak, P. Lancellotti, D. Poldermans, J.-U. Voigt, J. L. Zamorano, and on behalf of the European Association of Echocardi Stress echocardiography expert consensus statement: European Association of Echocardiography (EAE) (a registered branch of the ESC) Eur J Echocardiogr, July 1, 2008; 9(4): 415 - 437. [Abstract] [Full Text] [PDF]

				J M A Swinburn and R Senior Myocardial viability assessed by dobutamine stress echocardiography predicts reduced mortality early after acute myocardial infarction: determining the risk of events after myocardial infarction (DREAM) study Heart, January 1, 2006; 92(1): 44 - 48. [Abstract] [Full Text] [PDF]

				Y. Matsumura, T. Hozumi, K. Arai, K. Sugioka, K. Ujino, Y. Takemoto, H. Yamagishi, M. Yoshiyama, and J. Yoshikawa Non-invasive assessment of myocardial ischaemia using new real-time three-dimensional dobutamine stress echocardiography: comparison with conventional two-dimensional methods Eur. Heart J., August 2, 2005; 26(16): 1625 - 1632. [Abstract] [Full Text] [PDF]

				A. D'Andrea, S. Severino, P. Caso, B. Liccardo, A. Forni, A. Fusco, R. Lo Piccolo, M. Scherillo, N. Mininni, and R. Calabro Prognostic value of supine bicycle exercise stress echocardiography in patients with known or suspected coronary artery disease Eur J Echocardiogr, August 1, 2005; 6(4): 271 - 279. [Abstract] [Full Text] [PDF]

				R. Moreno, A. Villate, J. Zamorano, C. Almeria, J.-A. Perez-Gonzalez, J.-L. Rodrigo, L. P. de Isla, L. Mataix, and C. Macaya Identifying patients without favourable long-term outcome among those with medically stabilized unstable angina and a negative dipyridamole stress echocardiogram Eur J Echocardiogr, June 1, 2004; 5(3): 205 - 211. [Abstract] [Full Text] [PDF]

				D.V Anand, I.D Theodosiadis, and R Senior Improved interpretation of dobutamine stress echocardiography following 4 months of systematic training in patients following acute myocardial infarction Eur J Echocardiogr, January 1, 2004; 5(1): 12 - 17. [Abstract] [Full Text] [PDF]

				A D'Andrea, S Severino, P Caso, L De Simone, B Liccardo, A Forni, M Pascotto, G Di Salvo, M Scherillo, N Mininni, et al. Prognostic value of pharmacological stress echocardiography in diabetic patients Eur J Echocardiogr, September 1, 2003; 4(3): 202 - 208. [Abstract] [Full Text] [PDF]

				C. A. Visser and F. Nijland Current Status of Echocardiography for Detection of Myocardial Ischemia and Viability Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2003; 7(1): 41 - 43. [PDF]

				R. Sicari, E. Pasanisi, L. Venneri, P. Landi, L. Cortigiani, E. Picano, and Echo Persantine International Cooperative (EPIC) a Stress echo results predict mortality: a large-scale multicenter prospective international study J. Am. Coll. Cardiol., February 19, 2003; 41(4): 589 - 595. [Abstract] [Full Text] [PDF]

				R. Bholasingh, J. H. Cornel, O. Kamp, J. P. van Straalen, G. T. Sanders, J. G. P. Tijssen, V. A. W. M. Umans, C. A. Visser, and R. J. de Winter Prognostic value of predischarge dobutamine stress echocardiography in chest pain patients with a negative cardiac troponin T J. Am. Coll. Cardiol., February 19, 2003; 41(4): 596 - 602. [Abstract] [Full Text] [PDF]

				R. Sicari, P. Landi, E. Picano, S. Pirelli, G. Chiaranda, M. Previtali, G. Seveso, N. Gandolfo, F. Margaria, O. Magaia, et al. Exercise-electrocardiography and/or pharmacological stress echocardiography for non-invasive risk stratification early after uncomplicated myocardial infarction. A prospective international large scale multicentre study Eur. Heart J., July 1, 2002; 23(13): 1030 - 1037. [Abstract] [Full Text] [PDF]

				D. Pellerin and S.J.D. Brecker A step further in inter-institutional agreement in interpretation of dobutamine stress echocardiograms Eur. Heart J., May 2, 2002; 23(10): 768 - 771. [Full Text] [PDF]

				R Sicari, A Ripoli, E Picano, A.C Borges, A Varga, W Mathias, L Cortigiani, R Bigi, J Heyman, S Polimeno, et al. The prognostic value of myocardial viability recognized by low dose dipyridamole echocardiography in patients with chronic ischaemic left ventricular dysfunction Eur. Heart J., May 2, 2001; 22(10): 837 - 844. [Abstract] [PDF]

				M Sitges, C Pare, M Azqueta, X Bosch, M VelamazaN, J Magrina, and G Sanz Feasibility and prognostic value of dobutamine-atropine stress echocardiography early in unstable angina Eur. Heart J., July 1, 2000; 21(13): 1063 - 1071. [Abstract] [PDF]

				N.E. Mezilis, F.I. Parthenakis, M.K. Kanakaraki, M.E. Marketou, H.E. Mavrakis, and P.E. Vardas Dobutamine- vs exercise-induced ST segment elevation early after Q wave myocardial infarction. Prediction of functional recovery after revascularization Eur. Heart J., May 2, 2000; 21(10): 814 - 822. [Abstract] [PDF]

				A. Pingitore, E. Picano, A. Varga, G. Gigli, L. Cortigiani, M. Previtali, G. Minardi, M. Quarta Colosso, J. Lowenstein, W. Mathias Jr., et al. Prognostic value of pharmacological stress echocardiography in patients with known or suspected coronary artery disease: A prospective, large-scale, multicenter, head-to-head comparison between dipyridamole and dobutamine test J. Am. Coll. Cardiol., November 15, 1999; 34(6): 1769 - 1777. [Abstract] [Full Text] [PDF]

				M.-J. Hung, C.-H. Wang, and W.-J. Cherng Can Dobutamine Stress Echocardiography Predict Cardiac Events in Nonrevascularized Diabetic Patients Following Acute Myocardial Infarction? Chest, November 1, 1999; 116(5): 1224 - 1232. [Abstract] [Full Text] [PDF]

				A. Salustri, M. Ciavatti, F. Seccareccia, and A. Palamara Prediction of cardiac events after uncomplicated acute myocardial infarction by clinical variables and dobutamine stress test J. Am. Coll. Cardiol., August 1, 1999; 34(2): 435 - 440. [Abstract] [Full Text] [PDF]

				J. Krivokapich, J. S. Child, D. O. Walter, and A. Garfinkel Prognostic value of dobutamine stress echocardiography in predicting cardiac events in patients with known or suspected coronary artery disease J. Am. Coll. Cardiol., March 1, 1999; 33(3): 708 - 716. [Abstract] [Full Text] [PDF]

				D. Poldermans, P. M. Fioretti, E. Boersma, J. J. Bax, I. R. Thomson, J. R. T. C. Roelandt, and M. L. Simoons Long-Term Prognostic Value of Dobutamine-Atropine Stress Echocardiography in 1737 Patients With Known or Suspected Coronary Artery Disease : A Single-Center Experience Circulation, February 16, 1999; 99(6): 757 - 762. [Abstract] [Full Text] [PDF]

				J. Meluzin, J. Cerny, M. Frelich, F. Stetka, L. Spinarova, J. Popelova, R. Stipal, and on behalf of the Investigators of This Multicenter Prognostic value of the amount of dysfunctional but viable myocardium in revascularized patients with coronary artery disease and left ventricular dysfunction J. Am. Coll. Cardiol., October 1, 1998; 32(4): 912 - 920. [Abstract] [Full Text] [PDF]

				E. Picano, R. Sicari, P. Landi, L. Cortigiani, R. Bigi, C. Coletta, A. Galati, J. Heyman, R. Mattioli, M. Previtali, et al. Prognostic Value of Myocardial Viability in Medically Treated Patients With Global Left Ventricular Dysfunction Early After an Acute Uncomplicated Myocardial Infarction : A Dobutamine Stress Echocardiographic Study Circulation, September 15, 1998; 98(11): 1078 - 1084. [Abstract] [Full Text] [PDF]

				M. Previtali, R. Fetiveau, L. Lanzarini, C. Cavalotti, and C. Klersy Prognostic value of myocardial viability and ischemia detected by dobutamine stress echocardiography early after acute myocardial infarction treated with thrombolysis J. Am. Coll. Cardiol., August 1, 1998; 32(2): 380 - 386. [Abstract] [Full Text] [PDF]

				L. Cortigiani, E. Picano, P. Landi, M. Previtali, S. Pirelli, P. Bellotti, R. Bigi, O. Magaia, A. Galati, E. Nannini, et al. Value of pharmacologic stress echocardiography in risk stratification of patients with single-vessel disease: a report from the echo-persantine and echo-dobutamine international cooperative studies J. Am. Coll. Cardiol., July 1, 1998; 32(1): 69 - 74. [Abstract] [Full Text] [PDF]