Dobutamine Stress Echocardiography in Patients With Stable Chronic Angina and a Low- or Medium-Risk on Exercise Testing: Usefulness for Assessing Long-Term Prognosis
Juan A Castillo-Morenoa, José L Ramos-Martína, Eduardo Molina-Labordaa, Rafael Florenciano-Sáncheza, Juan Ortega-Bernala
a Servicio de Cardiología, Hospital Santa María del Rosell, Cartagena, Murcia, Spain.
KeywordsStable angina. Prognosis. Exercise test. Stress echocardiography.
Introduction and objectives. The ability of stress echocardiography to provide prognostic information that supplements that obtainable from clinical data and exercise electrocardiography is still controversial. Our aim was to determine whether dobutamine stress echocardiography provides additional information on long-term prognosis after conventional exercise testing has indicated that a patient with chronic stable angina has a low or intermediate risk of a cardiac event. Patients and method. The study included consecutive patients with stable angina who were not found to be at high risk on a previous exercise test. All patients underwent dobutamine stress echocardiography. The mean follow-up period was 4.5±1.76 years. The single combined end-point was defined as death due to cardiac disease, nonfatal myocardial infarction, or hospitalization for unstable angina. Multivariate analysis was used to identify independent predictors of cardiac events. Results. There were 24 (19%) cardiac events in the 124 participants: four deaths due to cardiac disease, 10 nonfatal myocardial infarctions, and 10 hospitalizations for unstable angina. Associations were found between a higher event rate during follow-up and previous myocardial infarction, Duke treadmill score, and the detection of regional wall motion abnormalities indicative of multivessel disease by stress echocardiography. Conclusions. In patients with stable angina who have undergone an exercise test that indicates that they have a low or intermediate risk of cardiac events, dobutamine stress echocardiography provides additional prognostic information to that obtainable from clinical data and exercise testing.