Key result
Negative DSE shows a lower negative predictive value of ~89% for MACE versus negative ESE.
Why the study?
The risk factors of adverse cardiovascular events after a normal exercise or dobutamine stress echocardiography in patients without known CAD are not well established.
Does dobutamine stress echocardiography have a different negative predictive value for MACE compared to exercise stress echocardiography in patients without known CAD?
Cohort (n=705)
No
Does dobutamine stress echocardiography have a different negative predictive value for MACE compared to exercise stress echocardiography in patients without known CAD?
Absolute Event Rate: 10.8% vs 3%
p-value: p=0.001
In patients without known CAD, a negative dobutamine stress echocardiogram has a lower negative predictive value for MACE compared to a negative exercise stress echocardiogram.
Negative DSE yields lower NPV than ESE after normal results; leaves open whether identified risk factors warrant intensified surveillance.
Introduction: Stress echocardiography is a safe and cost-effective method of evaluating the patients with suspected coronary artery disease (CAD). However, the risk factors of an adverse cardiovascular event after a normal exercise (ESE) or dobutamine (DSE) stress echocardiography are not well established. Methods: A cohort of 705 patients without previous history of CAD and a negative ESE/DSE was studied. All studies were performed in a high-volume echocardiologic laboratory and interpreted by two experienced echocardiography-trained cardiologists. Patients with inconclusive studies and those with an evidence of myocardial ischemia were excluded. Demographic, echocardiographic and hemodynamic findings were recorded. Patients were followed for at least 2 years. Independent predictors of major adverse cardiovascular events (MACE) were determined by regression analysis. Results: During a period of 55.7±17.5 months, MACE occurred in 35 (5.0%) of patients. Negative predictive value (NPV) of DSE was 89.2%, which was significantly less than 96.5% for ESE in predicting the occurrence of MACE (P = 0.001). MACE occurred more frequently among older (≥65 years) men with preexisting diabetes, hypertension, and/or hyperlipidemia. During ESE, a higher maximum blood pressure*heart rate product for the achieved level of metabolic equivalent (METS) of tasks was also an independent predictor of MACE. Conclusion: Inability of patients to undergo traditional ESE that led to the choice of using DSE alternative reduces the NPV of the stress echocardiography among patients without previous history of CAD. A modest rise of heart rate and blood pressure in response to increased level of activity serves as favorable prognostic value and improves the NPV of stress echocardiography.
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Samiei et al. (2019) conducted a cohort in Suspected coronary artery disease (n=705). Dobutamine stress echocardiography vs. Exercise stress echocardiography was evaluated on Major adverse cardiovascular events (MACE) (p=0.001). Among patients with no known coronary artery disease, a negative dobutamine stress echocardiography had a significantly lower negative predictive value for major adverse cardiovascular events compared to a negative exercise stress echocardiography (89.2% vs 96.5%).
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