Prognostic value of left ventricular volume response during dobutamine stress echocardiography.
OBJECTIVE
An abnormal left ventricular volume response during dobutamine echocardiography identified patients with severe coronary artery disease. The aim of the study was to assess the prognostic value of left ventricular volume changes during dobutamine stress echocardiography in 136 patients.


RESULTS
Endpoints were defined as spontaneous cardiac events at follow-up. Left ventricular end-diastolic and end-systolic volume changes (abnormal response: < 10% and < 20% decrease, respectively) were compared with other clinical and stress test variables. During 18 +/- 7 months of follow-up, 31 cardiac events occurred: 12 hard events (cardiac death [n = 6], myocardial infarction [n = 6]) and 19 soft events (unstable angina [n = 16], congestive heart failure [n = 3]). End-diastolic volume response (P = 0.006), diabetes (P = 0.008), inducible wall motion abnormalities (P = 0.024), end-systolic volume response (P = 0.039) and inducible angina (P = 0.038) were related to a greater likelihood of cardiac events. The Cox regression analysis revealed end-diastolic volume response (odds ratio: 3.0; CI 1.44-6.32) and diabetes (odds ratio: 2.7; CI 1.28-5.69) to be independent predictors of spontaneous cardiac events. Diabetes (odds ratio: 4.0; CI 1.26-12.80) and < 40% baseline ejection fraction (odds ratio: 2.21; CI1.14-4.29) were independent predictors of hard events.


CONCLUSIONS
An abnormal end-diastolic volume response during dobutamine stress echocardiography identifies patients with an unfavourable outcome; they should be considered for more accurate prognostic stratification.
Coletta
C
C
Department of Cardiology, S. Spirito Hospital, Rome, Italy.
Galati
A
A
Ricci
R
R
Sestili
A
A
Guagnozzi
G
G
Re
F
F
Ceci
V
V
D000328:Adult; D000368:Aged; D002316:Cardiotonic Agents; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000503:physiopathology*; D018572:Disease-Free Survival; D004280:Dobutamine; D004452:Echocardiography / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012044:Regression Analysis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology*; D016276:Ventricular Function
D002316:Cardiotonic Agents; D004280:Dobutamine