title: Dobutamine-induced hypotension is an independent predictor for mortality in patients with left ventricular dysfunction following myocardial infarction.
abstract: Dobutamine echocardiography was performed on 297 patients after acute myocardial infarction to assess the prognostic value of dobutamine-induced hypotension in patients with left ventricular dysfunction. Patients were divided into two groups according to ejection fraction (group I, ejection fraction <0.45, n = 123; group II, ejection fraction > or =0.45, n = 174) and were followed for 20+/-8 months. Hypotension was defined as a decrease in systolic blood pressure > or =20 mm Hg, compared with baseline values. The incidence of hypotension was similar in groups I and II (23.6% vs. 18.4%, P = 0.28), and the hypotension was not related to positive dobutamine echocardiography. Univariate analysis showed that the development of hypotension was associated with a higher incidence of cardiac death in group I but not in group II. Multivariate analysis showed that dobutamine-induced hypotension was an independent predictor only for cardiac death in group I and was not related to any other cardiac events in either group. In conclusion, the development of hypotension during dobutamine stress can identify a subgroup with poor ventricular functional reserve and at high risk for cardiac death among patients complicated with left ventricular dysfunction.
authors.affiliation: Department of Medicine, Chang Gung Medical College, Chang Gung Memorial Hospital, Keelung, Taiwan.
authors.forename: C H
authors.initials: CH
authors.lastname: Wang
authors.forename: W J
authors.initials: WJ
authors.lastname: Cherng
authors.forename: M J
authors.initials: MJ
authors.lastname: Hung
mesh_terms: D000318:Adrenergic beta-Agonists; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D016757:Death, Sudden, Cardiac; D004280:Dobutamine; D004452:Echocardiography; D005260:Female; D006801:Humans; D007022:Hypotension / Q000139:chemically induced*; D008297:Male; D009203:Myocardial Infarction / Q000150:complications*; D011379:Prognosis; D013318:Stroke Volume / Q000187:drug effects; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000401:mortality*
chemical_list: D000318:Adrenergic beta-Agonists; D004280:Dobutamine