title: Prognostic significance of renal function in patients undergoing dobutamine stress echocardiography.
abstract: BACKGROUND
  Dobutamine stress echocardiography (DSE) is used for risk stratification of patients with suspected coronary artery disease (CAD). However, the prognostic value of DSE among the entire strata of renal function has yet to be determined. We assessed the prognostic value of renal function relative to DSE findings.
  
  
  METHODS
  We studied 2292 patients, divided into 729 (32%) patients with normal renal function [creatinine clearance (CrCl) >90 ml/min] and 1563 (68%) with renal dysfunction, classified as mild (CrCl: 60-90 ml/min) in 933, moderate (CrCl: 30-60 ml/min) in 502 and severe (CrCl < 30 ml/min) in 128 patients. All patients underwent DSE for the evaluation of known or suspected CAD and were followed for a mean of 8 years.
  
  
  RESULTS
  New wall motion abnormalities during DSE and mildly, moderately and severely abnormal CrCl were powerful independent predictors for all-cause mortality, cardiac death and hard cardiac events (cardiac death and non-fatal myocardial infarction). Kaplan-Meier curves demonstrated that patients with normal DSE and renal dysfunction have greater probability for cardiac death and hard cardiac events compared to those with normal renal function. The warranty of a normal DSE in the presence of moderate renal dysfunction was 15 and 36 months for 10 and 20% risk for cardiac death and hard cardiac events, respectively.
  
  
  CONCLUSIONS
  The presence and severity of renal dysfunction has additional independent prognostic value over DSE findings. The low-risk warranty period after a normal DSE is determined by the severity of renal dysfunction.
authors.affiliation: Department of Cardiology, Erasmus MC, 3015 GD Rotterdam, The Netherlands.
authors.forename: Stefanos E
authors.initials: SE
authors.lastname: Karagiannis
authors.forename: Harm H H
authors.initials: HH
authors.lastname: Feringa
authors.forename: Abdou
authors.initials: A
authors.lastname: Elhendy
authors.forename: Ron
authors.initials: R
authors.lastname: van Domburg
authors.forename: Michel
authors.initials: M
authors.lastname: Chonchol
authors.forename: Radosav
authors.initials: R
authors.lastname: Vidakovic
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: George
authors.initials: G
authors.lastname: Karatasakis
authors.forename: George
authors.initials: G
authors.lastname: Athanasopoulos
authors.forename: Dennis V
authors.initials: DV
authors.lastname: Cokkinos
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
mesh_terms: D000368:Aged; D004280:Dobutamine; D025401:Echocardiography, Stress; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007677:Kidney Function Tests / Q000379:methods; D008297:Male; D008875:Middle Aged; D011379:Prognosis
chemical_list: D004280:Dobutamine