title: Significance of hypotensive response during dobutamine stress echocardiography.
abstract: 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.
authors.affiliation: Vascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Martin
authors.initials: M
authors.lastname: Dunkelgrun
authors.forename: Sanne E
authors.initials: SE
authors.lastname: Hoeks
authors.forename: Abdou
authors.initials: A
authors.lastname: Elhendy
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Peter G
authors.initials: PG
authors.lastname: Noordzij
authors.forename: Harm H H
authors.initials: HH
authors.lastname: Feringa
authors.forename: Radosav
authors.initials: R
authors.lastname: Vidakovic
authors.forename: Stefanos E
authors.initials: SE
authors.lastname: Karagiannis
authors.forename: Olaf
authors.initials: O
authors.lastname: Schouten
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
mesh_terms: 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
chemical_list: D000319:Adrenergic beta-Antagonists