Key result
A lower increase in left ventricular ejection fraction during dobutamine stress echocardiography independently predicted hard cardiac events (HR 1.1; 95% CI 1.0-1.2).
Why the study?
Does the change in left ventricular ejection fraction during dobutamine stress echocardiography predict long-term cardiac events in patients with suspected or known coronary artery disease?
Cohort (n=106)
Does the change in left ventricular ejection fraction during dobutamine stress echocardiography predict long-term cardiac events in patients with suspected or known coronary artery disease?
Hazard Ratio: 1.1 (95% CI 1–1.2)
p-value: p=0.04
Failure of LVEF to significantly increase during dobutamine stress echocardiography identifies a higher-risk subgroup for late cardiac events, providing incremental prognostic value over clinical data and wall motion abnormalities.
May identify higher-risk CAD patients on dobutamine stress echo; extends observational data but should not yet change practice.
In Brief Objective Dobutamine stress echocardiography (DSE), using subjective wall motion scoring, provides incremental prognostic information over clinical data. The aim of the study was to test the additional prognostic value of left ventriclar ejection fraction (LVEF) changes during DSE at different stages. Methods The study population comprised 106 consecutive patients (mean age 60±11 years, 73% men) with suspected or known coronary artery disease referred for DSE. Stress-induced ischemia was defined as new or worsening wall motion abnormalities. LVEF was measured at rest, peak stress and recovery. Follow-up was successful in 104 (98%) patients. Four patients who underwent revascularization within 60 days were excluded from the analysis. End-points during follow-up were cardiac death, non-fatal myocardial infarction and late revascularization. Results During a mean follow-up of 5.3±2.1 years, 26% of patients died: 13% due to cardiac death, 6% patients experienced non-fatal myocardial infarction and 38% underwent late revascularization. Rest-to-peak LVEF increase was lower in patients who experienced cardiac death or non-fatal myocardial infarction (4.9±8.6 compared with 9.2±7.5, P=0.04) and any cardiac events (6.0±8.5 compared with 10.5±6.7, P=0.004). An inverse correlation was found between left ventricular ejection increase and the number of ischemic segments (P<0.0001). A multivariable Cox proportional hazard model demonstrated that, in addition to clinical data and new wall motion abnormalities, lower LVEF increase had an incremental prognostic value in predicting hard cardiac events (hazard ratio 1.1, 95% confidence interval 1.0–1.2). Conclusion Failure of LVEF to significantly increase during DSE, denoting more extensive ischemia, identifies a higher-risk subgroup for late cardiac events. To test the additional prognostic value of ejection fraction changes during dobutamine stress echocardiography (DSE) a study population of 106 consecutive patients with known or suspected coronary artery disease referred for DSE was considered; six patients were excluded because of incomplete follow up or early revascularization. Stress induced ischemia and left ventricle ejection fraction (LVEF) at different stages were assessed. During mean follow up of 5.3±72.1 years 19 hard cardiac events (death or non fatal myocardial infarction) and 38 revascularization occurred. LVEF increase was lower in patients who experienced hard or any cardiac events. An inverse correlation was found between the degree of LVEF increase and number of ischemic segments. Lower LVEF increase had incremental prognostic value over clinical data and induced wall motion abnormalities, for prediction of hard cardiac events. Failure of LVEF increase during DSE, related to extensive ischemia, identifies an higher risk subgroup for late cardiac events
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Pedone et al. (2005) conducted a cohort in Suspected or known coronary artery disease (n=106). Lower LVEF increase during dobutamine stress echocardiography vs. Higher LVEF increase was evaluated on Hard cardiac events (cardiac death or non-fatal myocardial infarction) (HR 1.1, 95% CI 1.0-1.2, p=0.04). A lower increase in left ventricular ejection fraction during dobutamine stress echocardiography independently predicted hard cardiac events (HR 1.1; 95% CI 1.0-1.2).
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