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Prognostic significance of ST-segment elevation during dobutamine stress echocardiography

Ana Lucia M Arruda1, Rodrigo B M Barretto, Clarence Shub

  • 1Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, MN, USA.

American Heart Journal
|March 1, 2006
PubMed

Insights

New ST-segment elevation during dobutamine stress echocardiography (DSE) indicates severe coronary artery disease (CAD) and a high risk of cardiac events. Patients experiencing this DSE finding warrant consideration for coronary angiography.

Area of Science:

  • Cardiology
  • Diagnostic Imaging
  • Clinical Medicine

Background:

  • Limited data exist on the prognostic significance of ST-segment elevation during dobutamine stress echocardiography (DSE).
  • Assessing ST-segment elevation during DSE is crucial for understanding its link to coronary artery disease (CAD) severity.

Purpose of the Study:

  • To evaluate the prognostic importance of new ST-segment elevation observed during DSE.
  • To determine the relationship between ST-segment elevation during DSE and the severity of angiographically confirmed CAD.

Main Methods:

  • Identified 134 patients (3%) with new ST-segment elevation (>=1 mm) during DSE from a cohort of 4240 patients.
  • Defined significant CAD as >=50% diameter obstruction via angiography.
  • Monitored cardiac events during follow-up for prognostic assessment.

Main Results:

  • ST-segment elevation occurred in anterior, inferior, and lateral leads in a significant proportion of patients; 42% had elevation in multiple regions.
  • All patients had abnormal DSE findings, with 86% showing ischemia. Of those who underwent angiography (51%), 99% had >=70% stenosis, and 77% had multivessel disease.
  • Over a 2.6-year follow-up, 77% of patients experienced cardiac events, including death (53) and myocardial infarction (12), with event-free survival declining significantly over time.

Conclusions:

  • Stress-induced ST-segment elevation during DSE is a strong indicator of severe CAD.
  • Patients exhibiting ST-segment elevation during DSE face a high risk of future cardiac events.
  • Coronary angiography is recommended for patients with ST-segment elevation during DSE to confirm disease severity and guide management.
Abstract

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