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Prognostic value of dobutamine echocardiography in patients with intermediate coronary lesions at angiography
Stefano Ciaroni1, Antoine Bloch, Jacques Lars Hoffmann
1Medical/Surgical Cardiovascular Department, Hôpital de la Tour, Meyrin-Geneva, Switzerland.
Insights
Dobutamine echocardiography (DOBU-ECHO) can predict cardiac events in patients with intermediate coronary lesions. A positive DOBU-ECHO indicates higher risk, while a negative result suggests a low cardiac event risk.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Preventive Cardiology
Background:
- The prognostic implications of intermediate coronary lesions (30-50% stenosis) remain unclear.
- Dobutamine echocardiography (DOBU-ECHO) is a stress test used to assess myocardial ischemia.
Purpose of the Study:
- To evaluate the prognostic value of DOBU-ECHO in patients with intermediate coronary lesions.
- To determine if DOBU-ECHO can identify patients at higher risk for cardiac events.
Main Methods:
- Ninety-four patients with intermediate coronary lesions underwent DOBU-ECHO.
- Patients were followed for an average of 64 months for cardiac events.
- DOBU-ECHO results were correlated with cardiac event incidence.
Main Results:
- A positive DOBU-ECHO was observed in 23 patients, and a negative result in 71.
- Patients with positive DOBU-ECHO had a significantly higher annual cardiac event incidence (7.9%) compared to those with negative results (0.5%).
- This included a higher incidence of spontaneous events like myocardial infarction and cardiac death.
Conclusions:
- A positive DOBU-ECHO serves as an independent risk factor for cardiac events in patients with intermediate coronary lesions.
- A negative DOBU-ECHO is associated with a low risk of cardiac events, aiding risk stratification.
Unlabelled:
The prognostic value of dobutamine echocardiography (DOBU-ECHO) in patients with intermediate coronary lesions has not been described in the literature. The aim of this study was to determine the prognostic value of DOBU-ECHO in patients presenting with coronary lesions smaller than 50% at angiography. Ninety-four consecutive patients were analyzed and followed-up for 64 +/- 7 months (range: 12 to 75 months). All patients presented with coronary lesions between >or= 30% and < 50% of the luminal diameter of at least one major epicardial vessel. The patient population was divided into two groups: Those with a positive DOBU-ECHO (n = 23) and those with a negative DOBU-ECHO (n = 71). The number of coronary lesions did not differ between the two groups. The patients with a positive DOBU-ECHO result were more likely than those in the negative group to have a family history of coronary artery disease or suffer from hypertension or a dyslipidemia. During the follow-up period, 13 cardiac events occurred (1 cardiac death, 5 myocardial infarctions, 2 unstable anginas, and 5 myocardial revascularizations), 11 (47.8%) of which occurred in patients with positive DOBU-ECHO. The annual incidence for a cardiac event was 7.9% per year in the positive DOBU-ECHO group and 0.5% per year in the negative DOBU-ECHO group (P < 0.001). This incidence remained significant for spontaneous cardiac events, such as cardiac death, myocardial infarction, and unstable angina (5.8% per year vs 0.2% per year; P < 0.001).
Conclusions:
In patients with angiographically confirmed intermediate coronary lesions, a positive DOBU-ECHO is an additional risk factor for the onset of a cardiac event, whereas a negative DOBU-ECHO can be used to define patients with a low cardiac risk.