title: Prognostic value of dobutamine stress echocardiography in patients with systemic hypertension and known or suspected coronary artery disease.
abstract: Currently, there are no outcome data to suggest an incremental value of stress echocardiography in the risk stratification of patients who have hypertension after controlling for the left ventricular mass index (LVMI). This study assessed the incremental value of dobutamine stress echocardiography (DSE) for the prediction of mortality rate and cardiac events in patients who have hypertension. We studied 596 patients who had hypertension (mean age 62 +/- 12 years; 382 men) and who underwent DSE for evaluation of known or suspected coronary artery disease. End points during follow-up were hard cardiac events (cardiac death and nonfatal myocardial infarction) and total mortality rate. Left ventricular hypertrophy was detected by echocardiography in 119 patients (20%). During a median follow-up of 3 years, 101 patients (17%) died (43 cardiac deaths) and 19 patients had nonfatal myocardial infarction. In an incremental multivariate analysis model, clinical predictors of hard cardiac events were age, history of congestive heart failure, and LVMI. The percentage of abnormal myocardial segments examined with DSE was incremental to the clinical model (chi square 41 vs 27, p <0.001). Clinical predictors of total mortality rate were age, smoking, hypercholesterolemia, history of congestive heart failure, and LVMI. The peak wall motion score index was incremental to the clinical model (chi square 45 vs 40, p <0.05). DSE provides incremental data for the prediction of mortality rate and hard cardiac events in patients who have hypertension after adjustment for clinical data and LVMI.
authors.affiliation: Thoraxcentre, Erasmus Medical Centre, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
authors.forename: Fabiola B
authors.initials: FB
authors.lastname: Sozzi
authors.forename: Abdou
authors.initials: A
authors.lastname: Elhendy
authors.forename: Vittoria
authors.initials: V
authors.lastname: Rizzello
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: Miklos
authors.initials: M
authors.lastname: Kertai
authors.forename: Eleni
authors.initials: E
authors.lastname: Vourvouri
authors.forename: Arend F
authors.initials: AF
authors.lastname: Schinkel
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Jos R
authors.initials: JR
authors.lastname: Roelandt
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
mesh_terms: D002316:Cardiotonic Agents; D016009:Chi-Square Distribution; D003327:Coronary Disease / Q000150:complications* / Q000000981:diagnostic imaging* / Q000401:mortality; D004280:Dobutamine; D025401:Echocardiography, Stress; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D018709:Statistics, Nonparametric
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine