Long-term prediction of mortality in elderly persons by dobutamine stress echocardiography.
BACKGROUND
Dobutamine stress echocardiography (DSE) was shown to provide incremental prognostic information. However, its role in the prediction of mortality in elderly persons is not well defined. We assessed the value of DSE in the prediction of mortality and hard cardiac events during long-term follow-up in patients older than 65 years.


METHODS
We studied 1434 patients >65 years old (mean age 72 +/- 3 years) who underwent DSE for evaluation of coronary artery disease. Ischemia was defined as new or worsening wall motion abnormalities. Follow-up events were total mortality and hard cardiac events (cardiac mortality and nonfatal myocardial infarction). Multivariable Cox regression analysis was used to identify the independent predictors of follow-up events.


RESULTS
Ischemia was detected in 675 patients (47%). Five hundred six patients (35%) had a normal study, and 253 (18%) had fixed wall motion abnormalities. During a mean follow-up of 6.5 years, 532 (37%) deaths occurred, of which 249 (17%) were due to cardiac causes. A nonfatal myocardial infarction occurred in 45 patients (3%). Independent predictors of all-cause mortality in a multivariate analysis model were age (hazard ratio [HR] 1.06; 95% confidence interval [CI], 1.05-1.08), male sex (HR 1.5; 95% CI, 1.2-1.8), hypertension (HR 1.2; 95% CI, 1.1-1.4), smoking (HR 1.3; 95% CI, 1.1-1.6), diabetes (HR 1.4; 95% CI, 1.1-1.8), rest wall motion abnormalities (HR 1.07; 95% CI, 1.06-1.09), and ischemia (HR 1.3; 95% CI, 1.1-1.6). Independent predictors of hard cardiac events were age (HR 1.07; 95% CI, 1.05-1.09), male sex (HR 1.3; 95% CI, 1.1-1.7), smoking (HR 1.3; 95% CI, 1.1-1.6), diabetes (HR 1.6; 95% CI, 1.2-2.2), rest wall motion abnormalities (HR 1.13; 95% CI, 1.12-1.16), and ischemia (HR 2.1; 95% CI, 1.5-2.8).


CONCLUSIONS
DSE provides independent prognostic information to predict all-cause mortality and hard cardiac events in elderly patients.
Biagini
Elena
E
Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
Elhendy
Abdou
A
Schinkel
Arend F L
AF
Rizzello
Vittoria
V
Bax
Jeroen J
JJ
Sozzi
Fabiola B
FB
Kertai
Miklos D
MD
van Domburg
Ron T
RT
Krenning
Boudewijn J
BJ
Branzi
Angelo
A
Rapezzi
Claudio
C
Simoons
Maarten L
ML
Poldermans
Don
D
D000368:Aged; D003327:Coronary Disease / Q000401:mortality; D004280:Dobutamine; D025401:Echocardiography, Stress; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D009026:Mortality
D004280:Dobutamine