Prognostic power of dobutamine echocardiography after uncomplicated acute myocardial infarction in the elderly.
OBJECTIVE
To assess the prognostic value of dobutamine-atropine stress echocardiography (DSE) after uncomplicated acute myocardial infarction (AMI) in elderly patients.


METHODS
We analyzed 59 consecutive patients (42 men) aged > or = 70 years (mean +/- SD age, 75 +/- 4 years) who underwent DSE within 10 days after uncomplicated AMI. DSE was carried out following the standard protocol. Five myocardial responses were considered: (1) negative, (2) sustained improvement of contractility, (3) biphasic response (initial improvement followed by worsening), (4) worsening of contractility in the infarcted area, and (5) worsening at a distance.


RESULTS
Mean follow-up duration was 13 +/- 8 months. Twenty-one patients had an event: cardiac death (n = 5), myocardial infarction (n = 1), heart failure (n = 1), unstable angina (n = 10), and revascularization (n = 4). Clinical and stress echocardiographic variables previously related to adverse prognosis were entered in Cox regression analysis, and the predictors of impaired outcome were inducible ischemia during DSE (hazard ratio [HR], 2.97; 95% confidence interval [CI], 1.77 to 4.99; p < 0.001) and resting wall motion score index (WMSI) > 1.6 (HR, 1.68; 95% CI, 1.02 to 2.77; p = 0.04). After excluding revascularization procedures and considering only spontaneous events, the following predictors were found: ischemia during DSE (HR, 2.95; 95% CI, 2.78 to 3.12; p < 0.001) and resting WMSI > 1.6 (HR, 2.53; 95% CI, 1.30 to 4.93; p = 0.006).


CONCLUSIONS
Inducible ischemia during DSE within 10 days after uncomplicated AMI predicts an impaired outcome in the elderly.
de la Torre
M M
MM
Instituto de Ciencias del Corazón, Hospital Universitario, Valladolid, Spain.
San Román
J A
JA
Bermejo
J
J
Pastor
G
G
Alonso
J
J
Fernández-Avilés
F
F
D000368:Aged; D004280:Dobutamine; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D009200:Myocardial Contraction / Q000502:physiology; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D012016:Reference Values; D018570:Risk Assessment; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology
D004280:Dobutamine