title: Usefulness of rest and low-dose dobutamine wall motion scores in predicting survival and benefit from revascularization in patients with ischemic cardiomyopathy.
abstract: 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.
authors.affiliation: Department of Medicine of Indiana University School of Medicine, Indianaplis, Indiana, USA. ssawada@iupui.edu
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Sawada
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Lewis
authors.forename: Judy
authors.initials: J
authors.lastname: Foltz
authors.forename: Agota
authors.initials: A
authors.lastname: Ando
authors.forename: Samer
authors.initials: S
authors.lastname: Khouri
authors.forename: Shawn
authors.initials: S
authors.lastname: Kaser
authors.forename: Irmina
authors.initials: I
authors.lastname: Gradus-Pizlo
authors.forename: William
authors.initials: W
authors.lastname: Gill
authors.forename: Naomi
authors.initials: N
authors.lastname: Fineberg
authors.forename: Douglas
authors.initials: D
authors.lastname: Segar
authors.forename: Harvey
authors.initials: H
authors.lastname: Feigenbaum
mesh_terms: 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
chemical_list: D000318:Adrenergic beta-Agonists; D004280:Dobutamine