Dobutamine stress echocardiography for noninvasive assessment and risk stratification of patients with rheumatic mitral stenosis.
OBJECTIVE
We sought to evaluate the impact of dobutamine stress echocardiography (DSE) in patients with known rheumatic mitral stenosis (MS) in order to assess its safety, feasibility, and prognostic correlation to well-known clinical outcomes.


BACKGROUND
Noninvasive prognostic assessment of MS still represents an unresolved task in patients with clinically challenging disease.


METHODS
Dobutamine stress echocardiography was performed in 53 patients with MS (8 males; age 37.4 +/- 11.3 years) with no major complications.


RESULTS
During follow-up (60.5 +/- 11.0 months), 29 patients presented with clinical events: 16 hospitalizations, seven cases of acute pulmonary edema, and six symptomatic supraventricular arrhythmias. On multivariate analysis, the diastolic mitral valve mean gradient at peak DSE (DSE-MG) was the best predictor of clinical events (p < 0.008), especially in patients with moderate disease (p < 0.001). The best performance of DSE for the detection of clinical events was obtained at a cut-off value of 18 mm Hg DSE-MG (sensitivity 90%, specificity 87%, and accuracy 90%). The addition of DSE to the conventional cardiology work-up would allow a 17% increment for the detection of high-risk patients in the entire population and a 40% increment in patients with presumed moderate disease.


CONCLUSIONS
In patients with MS, DSE is a safe and highly feasible stress test. A DSE-MG > or =18 mm Hg identifies a subgroup of high-risk patients in whom a more aggressive approach may be warranted; on the other hand, patients with a DSE-MG <18 mm Hg predicts an uneventful clinical course and may justify a more conservative strategy.
Reis
Gilmar
G
Cardiovascular Research Program, Pontificia Universidade Catolica de Minas Gerais, R. Grao Para 454, Santa Efigenia, 30150-340 Belo Horizonte-MG, Brazil. greis@pucminas.br
Motta
Mauro S
MS
Barbosa
Marcia M
MM
Esteves
William A
WA
Souza
Sonia F
SF
Bocchi
Edimar A
EA
D000293:Adolescent; D000328:Adult; D002316:Cardiotonic Agents; D004280:Dobutamine; D015150:Echocardiography, Doppler / Q000379:methods*; D005080:Exercise Test / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging* / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies; D012214:Rheumatic Heart Disease / Q000150:complications / Q000000981:diagnostic imaging*; D018570:Risk Assessment; D016896:Treatment Outcome
D002316:Cardiotonic Agents; D004280:Dobutamine