The safety and clinical usefulness of dobutamine stress echocardiography among octogenarians.
BACKGROUND
Increasing numbers of octogenarians are being referred for investigation of chest pain. While dobutamine stress echocardiography (DSE) has been shown to be useful in younger patients, its role among octogenarians remains unclear. This investigation aimed to investigate the safety and prognostic benefits of DSE on cardiac events and total mortality in octogenarians.


METHODS
550 consecutive patients aged ≥80 years underwent DSE for suspected cardiac chest pain. All subjects were followed-up prospectively until March 2011, and the study end-points were a major cardiac event and total mortality.


RESULTS
One hundred and eighty-three (33%) patients had a positive DSE result, 271 (49%) had a normal study, and 164 (30%) had fixed-wall motion abnormalities. During a mean follow-up of 2.14±1.13 years, there were 217 (39%) cardiac events and 63 (11%) deaths, of which 46 (73%) were cardiac. The absolute risk of cardiac events increased with burden of ischaemia on DSE, from 13%/year (none), to 26%/year (1-3 ischaemic (LV) segments), and 38%/year (>3 ischaemic LV segments), p<0.001. Any ischaemia was associated with an additional 13 cardiac events per 100 person-years. In multivariate analysis, compared with non-ischaemic patients, the relative hazard of cardiac events for 1-3 and >3 ischaemic LV segments were 1.34 (95% CI 1.13 to 1.29) and 1.86 (95% CI 1.16 to 2.98), respectively. Addition of echocardiographic parameters to basic models improved the C statistic from 0.77 to 0.89 (p<0.001).


CONCLUSIONS
Among octogenarians referred with suspected cardiac chest pain, DSE is safe and, importantly, identifies a subset at high risk of cardiac events.
Department of Cardiology, St George's Healthcare NHS Trust, London, UK Canterbury Christ Church University, Kent, UK.
Jamie M
JM
O'Driscoll
Department of Cardiology, St George's Healthcare NHS Trust, London, UK.
Anna
A
Marciniak
St George's University of London, London, UK.
Kausik K
KK
Ray
Department of Cardiology, Ealing Hospital, Southall, UK.
Katharina
K
Schmid
Department of Cardiology, Harefield Hospital, Middlesex, UK.
Robert
R
Smith
Department of Cardiology, St George's Healthcare NHS Trust, London, UK.
Rajan
R
Sharma
D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000209:etiology; D002423:Cause of Death; D016009:Chi-Square Distribution; D025401:Echocardiography, Stress; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors