Adverse effect of increased left ventricular wall thickness on five year outcomes of patients with negative dobutamine stress.
BACKGROUND
To determine if patients without dobutamine induced left ventricular wall motion abnormalities (WMA) but an increased LV end-diastolic wall thickness (EDWT) exhibit a favorable cardiac prognosis.


RESULTS
Between 1999 and 2001, 175 patients underwent a dobutamine stress cardiovascular magnetic resonance (DCMR) procedure utilizing gradient-echo cines. Participants had a LV ejection fraction >55% without evidence of an inducible WMA during peak dobutamine/atropine stress. After an average of 5.5 years, all participants were contacted and medical records were reviewed to determine the post-DCMR occurrence of cardiac death, myocardial infarction (MI), and unstable angina (USA) or congestive heart failure (CHF) warranting hospitalization.In a multivariate analysis, that took into account Framingham and other risk factors associated with cardiac events, a cine gradient-echo derived LV EDWT > or =12 mm was associated independently with an increase in cardiac death and MI (HR 6.0, p = 0.0016), and the combined end point of MI, cardiac death, and USA or CHF warranting hospitalization (HR 3.0, p = 0.0005).


CONCLUSIONS
Similar to echocardiography, CMR measures of increased LV wall thickness should be considered a risk factor for cardiac events in individuals receiving negative reports of inducible ischemia after dobutamine stress. Additional prognostic studies of the importance of LV wall thickness and mass measured with steady-state free precession techniques are warranted.
Walsh
Thomas F
TF
Department of Internal Medicine (Cardiology Section), Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, USA. Thomas.Walsh@jax.ufl.edu
Dall'Armellina
Erica
E
Chughtai
Haroon
H
Morgan
Timothy M
TM
Ntim
William
W
Link
Kerry M
KM
Hamilton
Craig A
CA
Kitzman
Dalane W
DW
Hundley
W Gregory
WG
D000318:Adrenergic beta-Agonists; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000209:etiology; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D004280:Dobutamine; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000209:etiology; D015588:Observer Variation; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology
D000318:Adrenergic beta-Agonists; D004280:Dobutamine