Dobutamine stress echocardiography and exercise electrocardiography for risk stratification in medically treated unstable angina.
Previous reports have demonstrated the superiority of exercise echocardiography over exercise electro-cardiography (ex-ECG) for risk stratification in patients with medically stabilized unstable angina (UA). We sought to analyze the prognostic value of dobutamine stress echocardiography (DSE) compared with ex-ECG for risk stratification in patients with UA.


METHODS
Ninety-two patients with medically treated UA were studied (mean age 65 +/- 11 years, 24 women, 42% of patients had electrocardiographic abnormalities on admission). Dobutamine stress echocardiography and treadmill ex-ECG were performed on the third day after hospital admission. End points were recurrent UA, myocardial infarction (MI), or cardiac death.


RESULTS
Mean follow-up was 24 +/- 7 months. During follow-up, 22 patients had cardiac events (18 recurrent UA, 2 MI, 2 cardiac deaths). The event-free survival rate was 80% for patients with negative DSE results for ischemia and 52% for those with positive DSE results (log rank 9.57; P =.002), compared with an event-free survival rate of 79% for patients with negative ex-ECG results and 66% for those with positive ex-ECG results (log rank 2.06; P = not significant). Left ventricular dysfunction (P =.01) and a positive dobutamine stress echocardiogram (P =.03), but not a positive exercise electrocardiogram, were independent predictors of cardiac events during follow-up.


CONCLUSIONS
Dobutamine stress echocardiography performed early in medically treated patients with UA predicts cardiac events during follow-up more accurately and with more specificity than ex-ECG does in this population.
Sitges
M
M
Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Spain.
Azqueta
M
M
Paré
C
C
Magriñá
J
J
Miranda-Guardiola
F
F
Velamazán
M
M
Bosch
X
X
Sanz
G
G
D000368:Aged; D000789:Angina, Unstable / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000503:physiopathology*; D001794:Blood Pressure; D002316:Cardiotonic Agents; D016009:Chi-Square Distribution; D004280:Dobutamine; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006339:Heart Rate; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D018570:Risk Assessment / Q000379:methods; D015996:Survival Rate; D014463:Ultrasonography
D002316:Cardiotonic Agents; D004280:Dobutamine