Prognostic Value Of Dobutamine Echocardiography Research Articles

ACC/AHA/ASE 2003 Guideline Update for the Clinical Application of Echocardiography: Summary Article: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to update the 1997 guidelines for the clinical application of echocardiography)

ACC/AHA/ASE 2003 Guideline Update for the Clinical Application of Echocardiography: Summary Article: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to update the 1997 guidelines for the clinical application of echocardiography)

Prognostic value of dobutamine echocardiography in patients with intermediate coronary lesions at angiography.

The prognostic value of dobutamine echocardiography (DOBU-ECHO) in patients with intermediate coronary lesions has not been described in the literature. The aim of this study was to determine the prognostic value of DOBU-ECHO in patients presenting with coronary lesions smaller than 50% at angiography. Ninety-four consecutive patients were analyzed and followed-up for 64 +/- 7 months (range: 12 to 75 months). All patients presented with coronary lesions between >or= 30% and < 50% of the luminal diameter of at least one major epicardial vessel. The patient population was divided into two groups: Those with a positive DOBU-ECHO (n = 23) and those with a negative DOBU-ECHO (n = 71). The number of coronary lesions did not differ between the two groups. The patients with a positive DOBU-ECHO result were more likely than those in the negative group to have a family history of coronary artery disease or suffer from hypertension or a dyslipidemia. During the follow-up period, 13 cardiac events occurred (1 cardiac death, 5 myocardial infarctions, 2 unstable anginas, and 5 myocardial revascularizations), 11 (47.8%) of which occurred in patients with positive DOBU-ECHO. The annual incidence for a cardiac event was 7.9% per year in the positive DOBU-ECHO group and 0.5% per year in the negative DOBU-ECHO group (P < 0.001). This incidence remained significant for spontaneous cardiac events, such as cardiac death, myocardial infarction, and unstable angina (5.8% per year vs 0.2% per year; P < 0.001). In patients with angiographically confirmed intermediate coronary lesions, a positive DOBU-ECHO is an additional risk factor for the onset of a cardiac event, whereas a negative DOBU-ECHO can be used to define patients with a low cardiac risk.

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

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.

Dobutamine echocardiographic study in patients with nonischemic dilated cardiomyopathy and prognostically borderline values of peak exercise oxygen consumption: 18-month follow-up study

OBJECTIVESWe sought to study the prognostic value of dobutamine echocardiography in patients with nonischemic dilated cardiomyopathy (DCM) and prognostically borderline values of peak oxygen consumption (VO2max) during exercise.BACKGROUNDChanges in echocardiographic variables assessed by dobutamine echocardiography can be used to evaluate the functional status of patients with chronic heart failure (CHF) and DCM.METHODSIn 27 consecutive patients (mean age 55 ± 15 years) with VO2max values between 10 and 14 ml/kg body weight per min, a low infusion rate (10 μg/kg per min) dobutamine echocardiographic test was performed. The induced changes in echocardiographic variables were measured, and an 18-month follow-up study was done.RESULTSAt the end of the protocol, 9 patients (group I) had died from cardiac reasons, whereas the remaining 18 patients (group II) survived. After dobutamine infusion, the left ventricular end-systolic diameter (LVESD) was smaller in group II (6.22 ± 0.94 cm) than in group I (6.99 ± 0.76 cm; p < 0.05), whereas end-systolic wall stress (ESWS) was higher in group I (1030.66 ± 193.98 g/cm2) than in group II (691.57 ± 297.06 g/cm2; p < 0.05). The changes in LVESD and ESWS were greater in group I (0.75 ± 0.36 cm and 463.11 ± 159.87 g/cm2, respectively) than in group II (−0.04 ± 0.36 cm and 83.16 ± 291.74 g/cm2, respectively; p < 0.01 for both).CONCLUSIONSIn the “gray” zone of VO2max, dobutamine echocardiography seems to be a valuable prognostic indicator in patients with CHF and DCM.

Prognostic value of dobutamine echocardiography in patients after q-wave or non–q-wave acute myocardial infarction

We investigated the role of dobutamine echocardiography in predicting future spontaneous events in patients with Q-wave or non–Q-wave first acute myocardial infarction (AMI). DE was performed in 168 patients with a Q-wave AMI and 105 patients with a non–Q-wave AMI. Patients were observed for hard events (cardiac death and nonfatal reinfarction) and all spontaneous events (hard events and unstable angina). When compared to patients with a Q-wave AMI, patients with non–Q-wave AMI had a higher rate of positive dobutamine echocardiographic results (51.8% vs 80.0%, p <0.0001), greater changes in wall motion score index (WMSI) (0.31 ± 0.17 vs 0.42 ± 0.23, p = 0.001), and more remote zone ischemia (27.9% vs 43.8%, p = 0.0072). Patients with non–Q-wave infarct had a higher all-event rate, but a similar hard-event rate. In patients with a positive dobutamine echocardiogram (DE), the rate of hard or all events was similar, regardless of different infarct patterns. Patients with a negative DE had a higher event-free survival rate for all events in both Q-wave (85.2% vs 60.9%, p <0.0001) and non–Q-wave (76.2% vs 52.4%, p = 0.0083) groups. By stepwise analysis in the Q-wave group, the most important predictors were peak stress WMSI and diabetes for hard events, and a positive DE and baseline WMSI for all events. However, in the non–Q-wave group, the strongest predictors were dobutamine time for hard events and positive DE for all events. We conclude that a positive DE is a powerful predictor of future spontaneous events in patients after either a Q-wave or non–Q-wave AMI. However, for hard events, high-risk patients with different infarct patterns were recognized with variable efficiency by different dobutamine echocardiographic variables.

Prognostic Value of Dobutamine Echocardiography Is Compromised in Patients With Atrial Fibrillation Despite Adequate Stress

Prognostic Value of Dobutamine Echocardiography Is Compromised in Patients With Atrial Fibrillation Despite Adequate Stress

Prognostic value of dobutamine echocardiography in prediction of late recovery of regional myocardial dysfuction in patients with acute myocardial infarction

Background and Objectives:Determining the presence of viable myocardium has prognostic and therapeutic implications in the treatment of acute myocardial infarction (AMI. The aim of this study was to assess the ability of dobutamine echocardiography (DE to detect viable myocardium and predict the late improvement of regional left ventricular dysfunction after AMI. Methods:Twenty-five patients (male 24, mean age 57±9.6 with AMI underwent DE (dobutamine:0, 5, 10 and 20 μ gm/kg/min in 4.8±2.2 days after infarction. Revascu- larization of infarct related artery was performed in 20 patients (percutaneous coronary angioplasty 18, coronary artery bypass graft surgery 2. A follow-up 2D-echocardiography was performed at 7.1±2.3 months after AMI. Results:1 Improvement of regional wall motion abnormality (RWMA was observed in 12 patients during DE(DE (+ group). Thirteen patients showed no improvement of RWMA(DE (- group). 2 In follow-up 2D-echocardiography, 10 patients showed improvement of RWMA among DE (+ group (positive predictive value=83.3%. Two patients showed improvement of RWMA among DE (- group (negative predictive value=84.6%. Sensitivity and specificity of DE in predictiong late recovery of RWMA were 83.3% and 84.6% each. DE performed in the early stage of AMI seems to be useful in prediction of late recovery of regional left ventricular dysfunction. (Korean Circulation J 1998;28(9 :1473-1479

Prognostic value of dobutamine echocardiography is compromised in patients with atrial fibrillation despite adequate stress

Prognostic value of dobutamine echocardiography is compromised in patients with atrial fibrillation despite adequate stress

Prognostic Value of Dobutamine Echocardiography Early After Uncomplicated Acute Myocardial Infarction: A Comparison With Exercise Electrocardiography

Objectives. This study sought to assess the relative prognostic power of dobutamine echocardiography and exercise electrocardiography after acute myocardial infarction.Background. The prognostic value of dobutamine echocardiography early after acute myocardial infarction has not yet been reported.Methods. One hundred seventy-eight patients (mean age 58 ± 9 years) with a first uncomplicated acute myocardial infarction underwent predischarge dobutamine echocardiography (5 to 40 μg/kg body weight per min, plus atropine if needed) and symptom-limited bicycle exercise electrocardiography and were followed up for 17 ± 13 months. Stress-induced dyssynergy and ST segment depression >1 mm were considered criteria of positivity for dobutamine echocardiography and exercise electrocardiography, respectively.Results. Dobutamine echocardiography was positive in 83 patients and exercise electrocardiography in 60. At follow-up there were 5 deaths, 6 nonfatal myocardial infarctions (11 hard events) and 20 cases of unstable angina. Dobutamine echocardiography and exercise electrocardiography had similar negative predictive values both for all events (88% and 86%, respectively) and for hard events (98% and 95%, respectively). The hard events rate was significantly higher in patients with positive rather than negative dobutamine echocardiography (relative risk [RR] 5.15, 95% confidence interval [CI] 1.14 to 23.16), although there was no difference between patients with positive and negative exercise electrocardiograms. When Cox analysis was performed, dobutamine echocardiography had an independent prognostic value both for all events (RR 2.88, 95% CI 1.37 to 6.08) and for hard events (RR 6.56, 95% CI 1.42 to 30.46).Conclusions. After uncomplicated acute myocardial infarction, dobutamine echocardiography and exercise electrocardiography have a similar high negative predictive value for both all events and hard events only. Positive dobutamine echocardiography, but not positive exercise electrocardiography, identifies a group of patients at higher risk of subsequent cardiac events.(J Am Coll Cardiol 1997;29:261–7)

Prognostic value of dobutamine echocardiography in patients with left ventricular dysfunction

This study sought to establish the prognostic implications of ischemic and viable myocardium identified by dobutamine echocardiography in patients with left ventricular dysfunction. Recent studies have suggested that in patients with viable myocardium identified by positron emission tomography, medical treatment is associated with recurrent cardiac events. Dobutamine echocardiography has been used to identify viable myocardium in patients with left ventricular dysfunction, but the prognostic significance of this test is undefined. One hundred thirty-six consecutive patients (mean [+/- SD] age 67 +/- 7.9 years; 104 men) with moderate or severe left ventricular dysfunction (left ventricular ejection fraction 30 +/- 5%) undergoing dobutamine echocardiography were included in the study. Dobutamine was administered using a standard incremental protocol (5 to 40 micrograms/kg body weight per min intravenously in 3-min stages) with additional atropine (1 mg intravenously) as required. Standard body weight echocardiographic views were digitized on-line and compared using a side-by-side display. Viable myocardium was identified by enhancement of regional function at low dose (< 10 micrograms); scar was diagnosed by akinesia at rest or dyskinesia without change and ischemia as new or worsening dysfunction. One hundred thirty patients (95%) were followed up for 16 +/- 8 months after the original study for major cardiac events (cardiac death, myocardial infarction or severe unstable angina requiring late myocardial revascularization). No significant complications occurred during dobutamine echocardiography. Viable myocardium was detected in 26 patients (19%), ischemia in 23 (17%), both viability and ischemia in 13 (10%) and scar in 74 (54%). Of 108 patients treated medically, 46 had viable or ischemic myocardium, and 62 had scar only. There were no significant differences in age or other clinical characteristics, stress response, left ventricular dimensions and ejection fraction between the two groups. Cardiac events occurred in 26 medically treated patients (24%): 18 died of cardiac-related causes; 4 had a nonfatal myocardial infarction; and 4 had late revascularization because of unstable angina. The event rate was greater in patients with viable or ischemic myocardium than those with scar (43% vs. 8%, p = 0.01 by log-rank test). In a Cox regression model, the presence of viable or ischemic myocardium was found to predict subsequent events (relative risk 3.51, p = 0.02) independently of ejection fraction and age. Viable or ischemic myocardium detected at dobutamine echocardiography in patients with left ventricular dysfunction is associated with an adverse prognosis, independent of age and ejection fraction.

Prognostic Value of Dobutamine Echocardiography in Patients with High Pretest Likelihood of Coronary Artery Disease

Prognostic Value of Dobutamine Echocardiography in Patients with High Pretest Likelihood of Coronary Artery Disease

Prognostic value of dobutamine echocardiography in patients with high pretest likelihood of coronary artery disease

To examine the value of transient regional asynergy on dobutamine stress echocardiography as a noninvasive predictor of future cardiac events, 51 symptomatic patients (aged 54 ± 9 years) with suspected coronary artery disease (CAD) were studied using an incremental regimen of 5, 10, 15 and 20 μg/kg/min. Pretest likelihood of CAD was (mean ± standard error of the percentage) 79.7 ± 5.6% before and 83.4 ± 5.2% after exercise electrocardiography using probability analysis based on age, sex and symptoms. Two-dimensional images were analyzed with reference to an 11-segment model and gave good interrater agreement. During 24 ± 4 months (range 19 to 32) of follow-up, 23 patients had events (1 myocardial infarction, 9 unstable angina, 10 coronary bypass surgery, 3 coronary angioplasty) and 28 were event free. Age, proportion with baseline asynergy and both pretest echocardiographic ejection fraction and its response to dobutamine were similar in these 2 groups (all p = not significant). Transient asynergy was seen in 17 of 23 patients (74%) with and 8 of 28 patients (29%) without events (p < 0.01); 5 of 6 patients (83%) with involvement of 3 segments had events. Myocardial infarction or unstable angina occurred in 8 of 25 (32%) with a positive and 2 of 26 (8%) with a negative stress echocardiogram (p < 0.05). Both exercise duration (389 ± 195 vs 517 ± 237 seconds, p < 0.05) and time to diagnostic ST-segment shift (291 ± 192 vs 447 ± 212 seconds, p = 0.05) were shorter in those with inducible asynergy. These data suggest that patients with probable CAD and a positive dobutamine echocardiogram are at higher risk of an adverse outcome. Dobutamine echocardiography may aid selection for coronary angiography and prognostic revascularization, particularly in patients unable to exercise.