[The prognostic value of dobutamine echocardiography after an uncomplicated acute myocardial infarct].
OBJECTIVE
The identification of patients at risk for future events after an infarction is mandatory. The aim of this study was to assess the prognostic value of dobutamine stress echocardiography after an uncomplicated myocardial infarction.


METHODS
One hundred and twenty five patients (mean age 65 +/- 11 years, males 82%) underwent dobutamine-echo within ten days after an uncomplicated myocardial infarction. Four myocardial responses were identified: a) negative; b) sustained improvement of myocardial contractility; c) initial improvement followed by worsening, and d) worsening at a distance or in the infarcted zone.


RESULTS
Mean follow-up was 7.4 +/- 4.6 months. An adverse outcome occurred in 47 patients: non cardiac death in 3, cardiac death in 6, myocardial infarction in 5, angina in 21, congestive heart failure in 2, and in 10 patients revascularization. Cox regression analysis showed that worsening of contractility was the best predictor for adverse events (p < 0.0001, relative risk 2.8; 95% confidence interval: 1.7-4.5). Non-smoking and previous angina were also predictors of adverse events (p = 0.003 and p = 0.04, respectively). Similar results were obtained after excluding the revascularized patients.


CONCLUSIONS
Sustained improvement of contractility in the infarcted region is not a predictor of adverse events. Asynergy at a distance or in the infarcted region during dobutamine echocardiography within ten days after an uncomplicated myocardial infarction predicts adverse cardiac events during follow-up. Therefore, dobutamine echocardiography could be used for risk stratification after acute myocardial infarction.
de la Torre
M del M
Mdel M
Servicio de Cardiología, Hospital Universitario, Valladolid.
San Román
J A
JA
Bermejo
J
J
Garcimartín
I
I
Paniagua
J
J
Sanz
O
O
García Morán
E
E
Vega
J L
JL
Alonso
J J
JJ
Torres
J
J
Fernández-Avilés
F
F
D000368:Aged; D000704:Analysis of Variance; D002316:Cardiotonic Agents / Q000008:administration & dosage; D004280:Dobutamine / Q000008:administration & dosage; D004452:Echocardiography / Q000379:methods* / Q000706:statistics & numerical data; D005080:Exercise Test / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging*; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors
D002316:Cardiotonic Agents; D004280:Dobutamine