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Cardiac Stress Test Induced by Dobutamine and Monitored by Cardiac Catheterization in Mice
Published on: February 10, 2013
Prognostic value of dobutamine stress echocardiography in patients with normal left ventricular systolic function
Abdou Elhendy1, Arend F L Schinkel, Jeroen J Bax
1Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA. Aelhendy@unmc.edu
Insights
Myocardial ischemia detected by dobutamine stress echocardiography significantly increases cardiac event risk in patients with normal left ventricular function. This finding highlights the prognostic value of stress imaging in low-risk populations.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Prognostic Biomarkers
Background:
- Patients with normal left ventricular systolic function are generally considered low-risk for cardiac events.
- Limited data exist on the prognostic implications of ischemia identified through stress imaging in this population.
Purpose of the Study:
- To evaluate the prognostic significance of dobutamine-induced myocardial ischemia.
- To assess outcomes in patients with normal left ventricular systolic function.
Main Methods:
- A study of 528 patients with normal baseline left ventricular systolic function.
- High-dose dobutamine-atropine stress echocardiography was performed.
- Follow-up averaged 4.7 years for death and hard cardiac events (cardiac death, myocardial infarction).
Main Results:
- Ischemia was detected in 24% of patients.
- The annual hard cardiac event rate was 5% for patients with ischemia versus 1.1% without.
- Ischemia was an independent predictor of hard cardiac events (RR 4.3) and all-cause mortality (RR 2.1).
Conclusions:
- Dobutamine-induced wall-motion abnormalities are independently linked to higher risks.
- This includes increased risk of all-cause mortality and hard cardiac events.
- These findings are significant for patients with normal baseline left ventricular function.
Background:
Patients with normal left ventricular systolic function are considered to be at a relatively low risk for cardiac events. There are scarce data regarding association of ischemia on stress imaging techniques with outcome in these patients.
Objectives:
We sought to assess the prognostic significance of dobutamine-induced myocardial ischemia for patients with normal left ventricular systolic function.
Methods:
We studied 528 patients with normal baseline left ventricular systolic function who underwent high-dose dobutamine-atropine stress echocardiography and were followed up for 4.7 +/- 2.1 years for occurrence of death and hard cardiac events (cardiac death and nonfatal myocardial infarction).
Results:
Ischemia (new wall-motion abnormalities) was detected in 127 patients (24%). Follow-up events were death in 69 patients (13%) and hard cardiac events in 55 patients (10%). The annual hard cardiac event rate was 5% for patients with ischemia and 1.1% for patients without. In a multivariate analysis model, ischemia was the only independent predictor of hard cardiac events (risk ratio [RR] 4.3, 95% confidence intervals [CI] 2.5-7.4). Predictors of all causes of mortality were advanced age (RR 1.08, CI 1.05-1.11), higher resting rate pressure product (RR 1.11, CI 1.02-1.22), and ischemia (RR 2.1, CI 1.2-3.6).
Conclusion:
Dobutamine-induced wall-motion abnormalities are independently associated with increased risk of all-cause mortality and hard cardiac events in patients with normal baseline left ventricular function.
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