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Prognostic value of dobutamine stress echocardiography in patients undergoing diagnostic coronary arteriography
R Senior1, P Soman, R S Khattar
1Department of Cardiology, Northwick Park and St. Mark's National Health Service Trust, Harrow, United Kingdom.
Insights
Dobutamine stress echocardiography effectively predicts cardiac events in patients with suspected coronary artery disease. This imaging technique proved superior to exercise electrocardiography and coronary arteriography for risk assessment.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Preventive Cardiology
Background:
- Prognostic value of dobutamine stress echocardiography (DSE) in suspected coronary artery disease (CAD) is understudied.
- Limited comparative data exists between DSE and coronary arteriography for risk prediction.
Purpose of the Study:
- To assess the prognostic value of DSE in patients with suspected CAD.
- To compare the predictive capabilities of DSE against coronary arteriography and exercise electrocardiography.
Main Methods:
- 121 patients with suspected CAD underwent DSE and coronary arteriography.
- Follow-up for cardiac events including death, myocardial infarction, unstable angina, and heart failure.
- Multivariate analysis of clinical, exercise, echocardiographic, and arteriographic data.
Main Results:
- Higher incidence of cardiac events in patients with inducible wall motion abnormalities (88%) versus those without (55%).
- Worse resting and peak stress wall motion score indexes in patients with cardiac events.
- Independent predictors of cardiac events: exercise duration, inducible wall motion abnormality, and peak stress wall motion score index.
Conclusions:
- Dobutamine stress echocardiography is a powerful predictor of future cardiac events.
- DSE demonstrates superiority over exercise electrocardiography and coronary arteriography in predicting cardiac events in chest pain evaluation.
Abstract:
There are only a few studies addressing the prognostic value of dobutamine stress echocardiography in patients with suspected coronary artery disease and none have assessed its value compared with coronary arteriography. Accordingly, graded dobutamine stress echocardiography was performed in 121 patients who underwent coronary arteriography based on symptoms and the findings of treadmill exercise electrocardiography. During the follow-up period of mean (SD) months (15 +/- 9) there were 41 cardiac events (death [n = 5], acute myocardial infarction [n = 2], unstable angina [n = 29], and congestive heart failure [n = 5]). There were a greater number of patients with inducible wall motion abnormality (88%) on dobutamine stress with cardiac events compared with those without (55%, p <0.001). The wall motion score indexes at rest (1.6 +/- 0.6) and at peak stress (2.1 +/- 0.8) were worse in patients with cardiac events compared with those without (1.2 +/- 0.3, p <0.001 and 1.5 +/- 0.6, p <0.001, respectively). When multivariate analysis was performed using clinical, exercise, echocardiographic, and coronary arteriographic data the independent predictors of cardiac events were exercise duration (p = 0.01), presence of inducible wall motion abnormality (p = 0.03), and wall motion score index at peak stress (p <0.001). Thus, dobutamine stress echocardiography is a powerful predictor of future cardiac events in patients undergoing exercise testing and coronary arteriography for evaluation of chest pain and is superior to both exercise electrocardiography and coronary arteriography for the prediction of subsequent cardiac events.