Prognostic value of dobutamine echocardiography in elderly patients with suspected coronary artery disease and an abnormal resting electrocardiogram.

Abstract

The prognostic value of dobutamine stress echocardiography (DE) in elderly patients over 70 years of age with suspected coronary artery disease (CAD) and an abnormal electrocardiogram (ECG) at rest has not been well documented. We investigated 158 consecutive outpatients (97 men) aged 76 +/- 4 years presenting with right bundle branch block with or without a left anterior hemiblock (41%), left bundle branch block (23%), or repolarization abnormalities (36%). The basic clinical and echocardiographic data were analyzed and correlated with the DE results. The patients were followed for a mean of 24 +/- 13 months. Twenty-three (14.5%) patients presented with a nonfatal cardiac event (CE). According to univariate analysis, the parameters associated with the onset of a CE included arterial hypertension, angina pectoris, anti-angina therapy, the presence of calcifications on the aortic valve and the ascending walls of the aorta, and the presence of segmental-contraction abnormalities of the left ventricle (LV) at rest during echocardiography. According to a Cox regression model, the only independent predictive parameter for the onset of a CE was the appearance of segmental-contraction abnormalities of the LV and their severity during peak dose administration during DE (odds ratio [OR] = 2.58, P < 0.001). This parameter remains independent when spontaneous CEs (myocardial infarction and unstable angina) were considered as endpoints (OR = 2.31, P < 0.001). DE is a safe and reliable method for investigating CAD in patients over 70 years of age with an abnormal resting ECG. In our study, the most predictive independent parameter for the onset of a CE was the appearance of segmental-contraction abnormalities of the LV and their severity during DE.