Significance of hypotensive response during dobutamine stress echocardiography.
BACKGROUND
In patients undergoing exercise testing a hypotensive response is associated with a poor prognosis. There is limited information regarding the prognostic significance of hypotension during dobutamine stress test. This study investigates the association between a severe hypotensive response during DSE and long-term prognosis.


METHODS
Patients (3381) underwent dobutamine stress echocardiography (DSE). Blood pressure was measured automatically at rest and at the end of every dose-step. Wall motion was scored using a 16-segement, 5-point score. Ischemia was defined by the presence of new wall motion abnormalities. Hypotensive response during DSE was defined as mild (MHR) when systolic blood pressure (SBP) dropped <20 mmHg between rest and peak stress, and severe (SHR) when SBP dropped <20 mmHg. During follow-up all cause mortality and MACE (cardiac death or non-fatal myocardial infarction) were noted.


RESULTS
MHR and SHR occurred in 936 (28%) and 521 (15%) patients, respectively. Independent predictors of SHR were older age, new or worsening wall motion abnormalities and history of hypertension. During follow-up of 4.5 (+/-3.3) years, 920 patients died, of which 555 due to cardiac causes, and 713 patients experienced a MACE. After adjustment for baseline characteristics and DSE results SHR during DSE was independently associated with increased long-term cardiac death (HR: 1.3, 95% CI: 1.03-1.6) and MACE (HR: 1.34, 95% CI: 1.1-1.6), while MHR was not associated with a worse outcome.


CONCLUSIONS
Severe hypotensive response during DSE independently predicts cardiac death and MACE in patients with known or suspected coronary artery disease.
Dunkelgrun
Martin
M
Vascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
Hoeks
Sanne E
SE
Elhendy
Abdou
A
van Domburg
Ron T
RT
Bax
Jeroen J
JJ
Noordzij
Peter G
PG
Feringa
Harm H H
HH
Vidakovic
Radosav
R
Karagiannis
Stefanos E
SE
Schouten
Olaf
O
Poldermans
Don
D
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000367:Age Factors; D003324:Coronary Artery Disease / Q000401:mortality; D025401:Echocardiography, Stress; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology; D007022:Hypotension / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D011379:Prognosis; D012720:Severity of Illness Index
D000319:Adrenergic beta-Antagonists