title: Prognostic value of dobutamine-atropine stress echocardiography early after acute myocardial infarction. Echo Dobutamine International Cooperative (EDIC) Study.
abstract: OBJECTIVE
  The aim of this multicenter, multinational, prospective, observational study was to assess the relative value of myocardial viability and induced ischemia early after uncomplicated myocardial infarction.
  
  
  BACKGROUND
  Dobutamine-atropine stress echocardiography allows evaluation of rest function (at baseline), myocardial viability (at low dose) and residual ischemia (peak dose, up to 40 micrograms with atropine up to 1 mg) in one test.
  
  
  METHODS
  Dobutamine-atropine stress echocardiography was performed 12 +/- 5 days (mean +/- SD) after a first uncomplicated acute myocardial infarction in 778 patients (677 men; mean age 58 +/- 10 years) with technically satisfactory rest echocardiographic study results. Patients were followed-up for 9 +/- 7 months.
  
  
  RESULTS
  Dobutamine-atropine stress echocardiographic findings were positive for myocardial ischemia in 436 of patients (56%) and negative in 342 (44%). During follow-up, there were 14 cardiac-related deaths (1.8% of the total cohort), 24 (2.9%) nonfatal myocardial infarctions and 63 (8%) hospital readmissions for unstable angina. One hundred seventy-four patients (22%) underwent coronary revascularization (bypass surgery or coronary angioplasty). Spontaneous events occurred in 61 of 436 patients with positive and 40 of 342 patients with negative findings on dobutamine-atropine stress echocardiography (14% vs. 12%, p = 0.3). When only spontaneously occurring events were considered, the most important predictor was myocardial viability (chi-square 9.7). Using the Cox proportional hazards model, only the presence of myocardial viability (hazard ratio [HR] 2.0, p < 0.002) and age (HR 1.03, p < 0.001) were predictive of spontaneously occurring events. When only hard cardiac events were considered, age was the strongest predictor (chi-square 3.6, p = 0.056), followed by wall motion score index (WMSI) at peak dose (chi-square 3.3, p = 0.06) and remote ischemia (chi-square 2.25, p = 0.1). When cardiac death was considered, WMSI at peak dose was the best predictor (HR 9.2, p < 0.0001).
  
  
  CONCLUSIONS
  During dobutamine stress, echocardiographic recognition of myocardial viability is more prognostically important than echocardiographic recognition of myocardial ischemia for predicting unstable angina, whereas WMSI at peak stress was the best predictor of cardiac-related death. Different events can be recognized with different efficiency by various stress echocardiographic variables.
authors.affiliation: CNR, Institute of Clinical Physiology, Pisa, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Sicari
authors.forename: E
authors.initials: E
authors.lastname: Picano
authors.forename: P
authors.initials: P
authors.lastname: Landi
authors.forename: A
authors.initials: A
authors.lastname: Pingitore
authors.forename: R
authors.initials: R
authors.lastname: Bigi
authors.forename: C
authors.initials: C
authors.lastname: Coletta
authors.forename: J
authors.initials: J
authors.lastname: Heyman
authors.forename: F
authors.initials: F
authors.lastname: Casazza
authors.forename: M
authors.initials: M
authors.lastname: Previtali
authors.forename: W
authors.initials: W
authors.lastname: Mathias
authors.forename: C
authors.initials: C
authors.lastname: Dodi
authors.forename: G
authors.initials: G
authors.lastname: Minardi
authors.forename: J
authors.initials: J
authors.lastname: Lowenstein
authors.forename: X
authors.initials: X
authors.lastname: Garyfallidis
authors.forename: L
authors.initials: L
authors.lastname: Cortigiani
authors.forename: M A
authors.initials: MA
authors.lastname: Morales
authors.forename: M
authors.initials: M
authors.lastname: Raciti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000000981:diagnostic imaging / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D001285:Atropine; D002316:Cardiotonic Agents; D002470:Cell Survival; D001026:Coronary Artery Bypass; D004280:Dobutamine; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine; D001285:Atropine