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J Am Coll Cardiol, 2003; 41:589-595, doi:10.1016/S0735-1097(02)02863-2 © 2003 by the American College of Cardiology Foundation |
* National Council of Research, Institute of Clinical Physiology, Pisa, Italy
Manuscript received June 4, 2002; revised manuscript received August 29, 2002, accepted September 20, 2002.
* Reprint requests and correspondence: Dr. Rosa Sicari, CNR, Institute of Clinical Physiology, Via G. Moruzzi, 1, 56125 Pisa, Italy.
rosas{at}ifc.cnr.it
OBJECTIVES: The purpose of this study was to assess the long-term value of pharmacologic stress echocardiography with either dipyridamole or dobutamine (DET) for prediction of cardiac death in patients with proven or suspected coronary artery disease (CAD).
BACKGROUND: Stress echocardiography is an established, cost-effective technique for the detection of CAD.
METHODS: From the Echo Persantine International Cooperative–Echo Dobutamine International Cooperative data bank, 7,333 patients (5,452 males; 59 ± 10 years) underwent pharmacologic stress echocardiography with either high-dose dipyridamole (0.84 mg/kg over 10 min) (n = 4,984) or high-dose dobutamine (up to 40 µg/kg/3 min) (n = 2,349) for diagnostic purposes. Patients were followed up for a mean of 2.6 years (range 1 to 206 months).
RESULTS: The DET was positive for myocardial ischemia in 2,854 (35%) patients and negative in 4,479 (61%) patients. During the follow-up there were 161 cardiac deaths (sudden death and fatal myocardial infarction) (2.1% of the total population). Kaplan-Meier survival estimates showed a significantly better outcome for those patients with a negative pharmacologic stress echocardiography test compared with those with a positive test (92 vs. 71.2%, p = 0.0000).
CONCLUSIONS: Pharmacologic stress echocardiography with either dipyridamole or dobutamine is effective in predicting cardiac death during a long-term follow-up. A negative stress echocardiography test result is related to a favorable outcome.
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