Usefulness of rest and low-dose dobutamine wall motion scores in predicting survival and benefit from revascularization in patients with ischemic cardiomyopathy.
This study examined the value of wall motion scores at rest and with low- and high-dose dobutamine infusion for prediction of outcome and benefit from revascularization in patients with ischemic cardiomyopathy. Follow-up was obtained in 139 patients with ischemic cardiomyopathy who had echocardiography at rest, and during low- (10 microg/kg/min) and high-dose dobutamine (maximal dose 50 microg/kg/min) infusion. Both rest and low-dose wall motion scores were multivariate predictors of cardiac death, but ischemia and peak dose scores were not predictors. Rest scores risk stratified patients into 3 groups: score (1.00 to 1.99) with 11% cardiac death; score (2.00 to 2.49) with 30% death; and score > or =2.50 with 47% death. One third of patients with rest scores > or =2.50 had improvement in scores to < 2.50 with low-dose dobutamine. Their frequency of cardiac death was reduced to 23% compared with 60% (p = 0.04) in those who remained with low-dose scores > or =2.50. Low-dose scores also identified those who benefited from revascularization. In patients with low-dose scores (1.00 to 1.99), the frequency of cardiac death was marginally lower in revascularized than nonrevascularized patients (10% vs 21%, p = 0.28). In patients with scores (2.00 to 2.49), revascularized patients had a significantly lower frequency of cardiac death than nonrevascularized patients (15% vs 41%, p < 0.05). The frequency of death in those with low-dose scores > or =2.50 was very high in both revascularized (75%) and nonrevascularized (56%, p = 0.42) patients. Thus, rest and low-dose wall motion scores enable risk stratification of patients with ischemic cardiomyopathy and identify those who do and do not benefit from revascularization.
Sawada
Stephen G
SG
Department of Medicine of Indiana University School of Medicine, Indianaplis, Indiana, USA. ssawada@iupui.edu
Lewis
Stephen J
SJ
Foltz
Judy
J
Ando
Agota
A
Khouri
Samer
S
Kaser
Shawn
S
Gradus-Pizlo
Irmina
I
Gill
William
W
Fineberg
Naomi
N
Segar
Douglas
D
Feigenbaum
Harvey
H
D000318:Adrenergic beta-Agonists / Q000008:administration & dosage; D000368:Aged; D004280:Dobutamine / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D009204:Myocardial Revascularization; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012107:Research Design; D012146:Rest; D012306:Risk; D015996:Survival Rate
D000318:Adrenergic beta-Agonists; D004280:Dobutamine