title: Predictors and prognostic significance of atrial fibrillation developed during dobutamine stress echocardiography: A propensity score-matched comparison.
abstract: OBJECTIVE
  Atrial fibrillation (AF) uncommonly occurs during dobutamine stress echocardiography (DSE). We aimed to characterize the predictors and long-term prognostic significance of AF during DSE.
  
  
  METHODS
  The clinical, echocardiographic, and outcome data of patients in sinus rhythm who developed AF during DSE were reviewed and compared to a propensity score-matched group of controls.
  
  
  RESULTS
  Atrial fibrillation developed in 73 (1% of 7026) patients (age 70±10 years, 58% men). Compared to 144 propensity score-matched controls without AF during DSE, those with AF were more likely to have had history of prior AF (23% vs 8%, P=.002), known coronary artery disease (CAD; 22% vs 10%, P=.037), enlarged left ventricle (LV; 27% vs 9%, P=.002), LV wall-motion abnormality (33% vs 12%, P<.0001), enlarged aortic root (22% vs 8%, P=.009), or dilated left atrium (52% vs 30%, P=.002). Multivariate logistic regression analysis identified prior history of AF (OR=3.7, 95% CI 1.5-9.0, P=.005), larger LV size (OR=3.1, 95% CI 1.3-7.3, P=.009), and lower LV ejection fraction (OR=-0.95, 95% CI -0.92 to -0.99, P=.02) as independent predictors of AF during DSE. At a mean follow-up period of 3.4 (0.5-7.3) years, those with AF during DSE were more likely to develop new coronary events (22% vs 10%, P=.0372), new-onset heart failure (19% vs 4%, P=.0003), or die from any cause (27% vs 6%, P<.0001). Kaplan-Meier curves demonstrated significantly lower event-free survival in patients compared to controls (P by log-rank test=.001) over the follow-up period.
  
  
  CONCLUSIONS
  Dobutamine-induced AF occurs more commonly in those with prior history of AF and remodeled LV and is associated with unfavorable outcomes.
authors.affiliation: Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA.
authors.forename: Yuba
authors.initials: Y
authors.lastname: Acharya
authors.affiliation: Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA.
authors.forename: Sahil
authors.initials: S
authors.lastname: Agrawal
authors.affiliation: Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA.
authors.forename: Junu
authors.initials: J
authors.lastname: Bhattarai
authors.affiliation: Departments of Cardiology, Geisinger Medical Center, Danville, PA, USA.
authors.forename: Vlad
authors.initials: V
authors.lastname: Cotarlan
authors.affiliation: Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA.
authors.forename: Jamshid
authors.identifier: http://orcid.org/0000-0003-0447-2542
authors.initials: J
authors.lastname: Shirani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D025401:Echocardiography, Stress / Q000379:methods*; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis
keywords: atrial fibrillation; dobutamine; dobutamine stress echocardiography; outcome; prognosis; propensity score matching