title: Prognostic value of dobutamine echocardiography early after uncomplicated acute myocardial infarction: a comparison with exercise electrocardiography.
abstract: OBJECTIVE
  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 micrograms/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.
authors.affiliation: Division of Cardiology, Hospital Sandro Pertini, Rome, Italy.
authors.forename: C A
authors.initials: CA
authors.lastname: Greco
authors.forename: A
authors.initials: A
authors.lastname: Salustri
authors.forename: F
authors.initials: F
authors.lastname: Seccareccia
authors.forename: M
authors.initials: M
authors.lastname: Ciavatti
authors.forename: F
authors.initials: F
authors.lastname: Biferali
authors.forename: C
authors.initials: C
authors.lastname: Valtorta
authors.forename: G
authors.initials: G
authors.lastname: Guzzardi
authors.forename: M
authors.initials: M
authors.lastname: Falcone
authors.forename: A
authors.initials: A
authors.lastname: Palamara
mesh_terms: D000368:Aged; D002316:Cardiotonic Agents; D004280:Dobutamine; D004452:Echocardiography; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D016019:Survival Analysis
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine