Prediction of mortality using dobutamine echocardiography

Area of Science:

• Cardiology
• Diagnostic Imaging
• Prognostic Biomarkers

Background:

• Existing dobutamine echocardiography (DbE) studies often used composite endpoints and short follow-up periods.
• Clinical and stress data were gathered from 3,156 patients undergoing DbE.
• Coronary angiography in 1,073 patients revealed significant stenoses in 70%.

Purpose of the Study:

• To determine if dobutamine echocardiography (DbE) provides independent prediction of total and cardiac mortality.
• To assess if DbE's predictive power is incremental to clinical and angiographic variables.

Main Methods:

• Utilized Cox models to analyze mortality predictors in 3,156 patients over nine years.
• Collected clinical, stress, and DbE data, including resting left ventricular function.
• Assessed the incremental predictive value of DbE and coronary anatomy in sequential models.

Main Results:

• Dobutamine echocardiograms were abnormal in 50% of patients; 23% experienced total mortality and 8% cardiac mortality.
• Ischemia and extent of abnormal wall motion were independent predictors of cardiac death, along with age and heart failure.
• DbE significantly enhanced the predictive power of clinical data for mortality.

Conclusions:

• Dobutamine echocardiography is a valuable, independent predictor of mortality, adding to existing clinical and angiographic information.
• A normal DbE is associated with a low annual cardiac death risk (approx. 1%).
• The risk of cardiac death increases with the severity of abnormal heart wall motion identified by DbE.