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CLINICAL STUDIES

Prognostic value of dobutamine stress echocardiography in predicting cardiac events in patients with known or suspected coronary artery disease

^a Division of Cardiology, Department of Medicine, UCLA School of Medicine, Los Angeles, California 90095-1679, USA

Manuscript received March 17, 1998; revised manuscript received October 16, 1998, accepted November 20, 1998.

Reprint requests and correspondence: Dr. Janine Krivokapich, UCLA School of Medicine, CHS 47-123, Los Angeles, California 90095-1679
jkrivoka{at}medicine.medsch.ucla.edu

OBJECTIVES

The study sought to determine the utility of dobutamine stress echocardiography (DSE) in predicting cardiac events in the year after testing.

BACKGROUND

Increasingly, DSE has been applied to risk stratification of patients.

METHODS

Medical records of 1,183 consecutive patients who underwent DSE were reviewed. The cardiac events that occurred during the 12 months after DSE were tabulated: myocardial infarction (MI), cardiac death, percutaneous transluminal coronary angioplasty (PTCA), and coronary artery bypass surgery (CABG). Patient exclusions included organ transplant receipt or evaluation, recent PTCA, noncardiac death, and lack of follow-up. A positive stress echocardiogram (SE) was defined as new or worsened wall-motion abnormalities (WMAs) consistent with ischemia during DSE. Classification and regression tree (CART) analysis identified variables that best predicted future cardiac events.

RESULTS

The average age was 68 ± 12 years, with 338 women and 220 men. The overall cardiac event rate was 34% if SE was positive, and 10% if it was negative. The event rates for MI and death were 10% and 8%, respectively, if SE was positive, and 3% and 3%, respectively, if SE was negative. If an ischemic electrocardiogram (ECG) and a positive SE were present, the overall event rate was 42%, versus a 7% rate when ECG and SE were negative for ischemia. Rest WMA was the most useful variable in predicting future cardiac events using CART: 25% of patients with and 6% without a rest WMA had an event. Other important variables were a dobutamine EF <52.5%, a positive SE, an ischemic ECG response, history of hypertension and age.

CONCLUSIONS

A positive SE provides useful prognostic information that is enhanced by also considering rest-wall motion, stress ECG response, and dobutamine EF.

Abbreviations and Acronyms   CABG = coronary artery bypass grafting surgery   CART = classification and regression tree analysis   DSE = dobutamine stress echocardiography   ECG = electrocardiogram   EF = ejection fraction   MI = myocardial infarction   PTCA = percutaneous transluminal coronary angioplasty   RPP = rate pressure product   SE = stress echocardiogram   WMA = wall-motion abnormality

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