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Stress echo results predict mortality: a large-scale multicenter prospective international study
Rosa Sicari1, Emilio Pasanisi, Lucia Venneri
1National Council of Research, Institute of Clinical Physiology, Via G. Moruzzi 1, 56125 Pisa, Italy. rosas@ifc.cnr.it
Insights
Pharmacologic stress echocardiography effectively predicts cardiac death in patients with coronary artery disease. A negative test indicates a favorable long-term outcome, highlighting its value in risk assessment.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Clinical Medicine
Background:
- Stress echocardiography is a recognized, cost-effective method for detecting coronary artery disease (CAD).
- Pharmacologic stress agents like dipyridamole and dobutamine are utilized when exercise stress testing is not feasible.
Purpose of the Study:
- To evaluate the long-term predictive value of pharmacologic stress echocardiography (DET) for cardiac death in patients with suspected or confirmed CAD.
- To assess the prognostic significance of positive versus negative DET results.
Main Methods:
- Analysis of data from 7,333 patients (59 ± 10 years) who underwent pharmacologic stress echocardiography (dipyridamole or dobutamine).
- Patients were followed for a mean of 2.6 years to track cardiac mortality.
- Kaplan-Meier survival analysis was used to compare outcomes based on test results.
Main Results:
- Pharmacologic stress echocardiography (DET) was positive for ischemia in 35% of patients and negative in 61%.
- A total of 161 cardiac deaths occurred during follow-up (2.1%).
- Patients with a negative DET had significantly better survival rates (92%) compared to those with a positive DET (71.2%, p=0.0000).
Conclusions:
- Pharmacologic stress echocardiography using dipyridamole or dobutamine is effective for predicting long-term cardiac death risk in patients with CAD.
- A negative stress echocardiography result is strongly associated with a favorable prognosis and survival.
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 microg/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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