Prognostic significance of submaximal negative dobutamine stress echocardiography: a 3-year follow-up study

To estimate the prognostic value of submaximal negative dobutamine stress echocardiography (NDSE) on major cardiac events.

Patients with NDSE were analyzed in 2 cohorts based on predicted maximal heart rate (PMHR) (< 85% or > or = 85% PMHR) and were assessed for major adverse cardiac events over 3 years. Of 756 patients with NDSE, 415 achieved > or = 85% PMHR. Both groups had comparable ejection fractions (EF) > 50% (80.6% vs. 81.9%, p = 0.66). The NsubDSE group had higher rates of atrioventricular nodal blocker use (58.7% vs. 39.9%, p < 0.0001), and diabetes (38.7% vs. 27.6%, p = 0.001). Kaplan-Meier survival analysis showed no differences in freedom from cardiac death (98% vs. 98%, p = 0.88), nonfatal myocardial infarction (94% vs. 94%, p = 0.85), or combined major cardiac events (81% vs. 78%, p = 0.24). Diabetes and preserved ejection fraction were predictive of cardiac events in a multi-variate analysis (p = 0.005).

In our study, NsubDSE carried a favorable prognosis. Diabetics were more likely to have an NsubDSE and suffer from a cardiac event despite a preserved ejection fraction. Hence further evaluation for coronary artery disease in this high risk cohort should be pursued.