Wall motion abnormalities with low-dose dobutamine predict a high risk of cardiac death in medically treated patients with ischemic cardiomyopathy.
BACKGROUND
Severe and extensive coronary artery disease is the underlying cause of stress-induced wall motion abnormalities (SWMA) with low-dose (10 microg/kg/min) dobutamine suggesting that these abnormalities may identify those with poor outcome.


OBJECTIVE
We assessed the prognostic value of low-dose SWMA in medically treated patients with ischemic cardiomyopathy.


METHODS
Low- and peak-dose dobutamine echocardiography was performed in 235 patients with ischemic cardiomyopathy (ejection fraction 31% +/- 8%) who were treated with medical therapy. The survival of patients with low-dose SWMA (n = 33) was compared with the survival of patients without ischemia (n = 85) and those with peak-dose SWMA (n = 117).


RESULTS
There were 123 cardiac deaths (52%) during follow-up of 4.1 +/- 3.3 years. Multivariate predictors of cardiac death were age (p = 0.002, hazard ratio [HR]: 1.03), diabetes (p = 0.028, HR: 1.54), New York Heart Association (NYHA) class III, IV heart failure (p = 0.001, HR: 1.94), the presence of peak dose SWMA (p < 0.001, HR: 2.59), and low-dose SWMA (p = 0.005, HR: 2.28). Survival of patients without ischemia was significantly better than those with peak-dose SWMA (p < 0.0001) and those with low-dose SWMA (p = 0.001). The survival of patients with low-dose SWMA was the same as those with peak-dose SWMA (p = 0.89).


CONCLUSIONS
Low-dose SWMA is an independent predictor of cardiac mortality in medically treated patients with ischemic cardiomyopathy. Patients with low-dose SWMA are at equivalent risk to those with peak-dose SWMA.
Maskoun
Waddah
W
Department of Medicine, Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana, USA.
Mustafa
Nowwar
N
Mahenthiran
Jothiharan
J
Gradus-Pizlo
Irmina
I
Kamalesh
Masoor
M
Feigenbaum
Harvey
H
Sawada
Stephen G
SG
D000368:Aged; D009202:Cardiomyopathies / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D002317:Cardiovascular Agents / Q000627:therapeutic use; D004280:Dobutamine / Q000008:administration & dosage; D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology
D002317:Cardiovascular Agents; D004280:Dobutamine