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[The prognostic value of dobutamine stress echocardiography. A long-term follow-up study]
1Interne Abteilung, Krankenhaus Floridsdorf, Wien.
Insights
Dobutamine stress echocardiography (DSE) is valuable for assessing coronary heart disease prognosis. A normal DSE finding in patients indicates a significantly lower risk of cardiac events and interventions.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Preventive Medicine
Background:
- Prognostic value of dobutamine stress echocardiography (DSE) in coronary heart disease (CHD) requires further assessment.
- Focus on cardiac events and interventions in patients with normal DSE findings.
Purpose of the Study:
- To evaluate the prognostic significance of DSE in patients with suspected or known CHD.
- Specifically assess the prognostic value of a normal DSE finding regarding cardiac events.
Main Methods:
- 316 patients with suspected/known CHD underwent DSE.
- DSE classified as normal-normal, normal-ischemic, abnormal-normal, abnormal-ischemic, or inconclusive.
- Follow-up for cardiac events (myocardial infarction, death) and interventions (revascularization).
Main Results:
- 161 patients had normal-normal DSE findings.
- Significantly lower event rates (P=0.03) and intervention rates (P=0.0001) in the normal-normal DSE group.
- Normal DSE findings correlate with better long-term outcomes.
Conclusions:
- Patients with normal DSE and normal resting echocardiography demonstrate a favorable long-term prognosis.
- DSE is a reliable tool for risk stratification in CHD patients.
Background And Objective:
The prognostic value of dobutamine stress echocardiography in patients with suspected or known coronary heart disease has not exactly been assessed. Purpose of the study was the assessment of the prognostic value of DSE regarding cardiac events, especially in patients with a normal DSE finding.
Patients And Methods:
316 patients (168 men, 148 women, mean age 61 +/- 10 years), included in this follow-up study, underwent DSE between January 1994 and December 1996 to evaluate clinically suspected or known coronary heart disease. DSE was classified according to resting and stress echocardiography as either "normal-normal (NN)", "normal-ischemic (NI)", "abnormal-normal (AN)", "abnormal-ischemic (AI)" or "inconclusive (C)". Follow-up by telephone took place between June 1997 and April 1998. "Events" were survived myocardial infarction and death. "Interventions" were revascularisation procedures, either percutaneous transluminal coronary angioplasty (PTCA) with or without stenting or aortocoronary bypass surgery.
Results:
In 161 patients, DSE was NN, NI in 27 patients, AN in 55 patients, AI in 54 patients and C in 19 patients. Mean follow-up duration was 28 months. Events occurred in 23 patients: survived myocardial infarction in 10, death in 13 persons. Interventions were carried out in 50 patients: PTCA with or without stenting in 19, aortocoronary bypass surgery in 31 persons. The event rate was significantly lower in patients with DSE classified as NN (P = 0.03 by log-rank) than in other groups. The intervention rate was significantly lower in the NN-group (P = 0.0001 by log-rank) than in the other groups, too.
Conclusion:
Patients with a normal rest echocardiography and DSE had a good prognosis in a long-term follow-up study.