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Dobutamine-induced hypotension is an independent predictor for mortality in patients with left ventricular
C H Wang1, W J Cherng, M J Hung
1Department of Medicine, Chang Gung Medical College, Chang Gung Memorial Hospital, Keelung, Taiwan.
Insights
Dobutamine stress testing can predict cardiac death risk in patients with left ventricular dysfunction. Hypotension during the test identifies high-risk individuals with poor heart function after myocardial infarction.
Area of Science:
- Cardiology
- Clinical Medicine
- Diagnostic Imaging
Background:
- Left ventricular dysfunction is a common complication after acute myocardial infarction.
- Assessing prognosis in these patients is crucial for guiding treatment strategies.
- Dobutamine echocardiography is a valuable tool for evaluating cardiac function under stress.
Purpose of the Study:
- To determine the prognostic significance of dobutamine-induced hypotension in patients post-myocardial infarction with left ventricular dysfunction.
- To identify whether dobutamine-induced hypotension predicts adverse cardiac events, specifically cardiac death.
Main Methods:
- Dobutamine echocardiography was conducted on 297 patients following acute myocardial infarction.
- Patients were stratified into two groups based on ejection fraction (<0.45 and >=0.45).
- Hypotension was defined as a systolic blood pressure decrease of >=20 mm Hg during dobutamine stress.
Main Results:
- Hypotension occurred in 23.6% of patients with ejection fraction <0.45 and 18.4% with ejection fraction >=0.45.
- Dobutamine-induced hypotension was an independent predictor of cardiac death exclusively in patients with reduced ejection fraction (group I).
- Hypotension was not associated with other cardiac events or positive dobutamine echocardiography findings.
Conclusions:
- Dobutamine-induced hypotension can identify a subgroup of patients with left ventricular dysfunction at high risk for cardiac death.
- This finding highlights the importance of monitoring blood pressure response during dobutamine stress echocardiography for risk stratification.
Abstract:
Dobutamine echocardiography was performed on 297 patients after acute myocardial infarction to assess the prognostic value of dobutamine-induced hypotension in patients with left ventricular dysfunction. Patients were divided into two groups according to ejection fraction (group I, ejection fraction <0.45, n = 123; group II, ejection fraction > or =0.45, n = 174) and were followed for 20+/-8 months. Hypotension was defined as a decrease in systolic blood pressure > or =20 mm Hg, compared with baseline values. The incidence of hypotension was similar in groups I and II (23.6% vs. 18.4%, P = 0.28), and the hypotension was not related to positive dobutamine echocardiography. Univariate analysis showed that the development of hypotension was associated with a higher incidence of cardiac death in group I but not in group II. Multivariate analysis showed that dobutamine-induced hypotension was an independent predictor only for cardiac death in group I and was not related to any other cardiac events in either group. In conclusion, the development of hypotension during dobutamine stress can identify a subgroup with poor ventricular functional reserve and at high risk for cardiac death among patients complicated with left ventricular dysfunction.