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(Circulation. 1997;95:1402-1410.)
© 1997 American Heart Association, Inc.
Articles |
Dobutamine Stress Echocardiography for Risk Stratification After Myocardial Infarction
Presented in part at the 43rd Scientific Session of the American College of Cardiology, Atlanta, Ga, March 13–17, 1994.
From the Division of Cardiology/Hypertension, Medical College of Wisconsin (Milwaukee).
Correspondence to Kiran B. Sagar, MD, Medical College of Wisconsin, Division of Cardiology, FMLH-East, 9200 W Wisconsin Ave, Milwaukee, WI 53226.
Background Because dobutamine stress echocardiography (DSE) provides assessment of left ventricular function and ischemia at a distance, the major determinants of adverse outcome after acute myocardial infarction (AMI), we undertook this study to determine the role of DSE in risk stratification after AMI.
Methods and Results A graded DSE in 5-minute stages was
performed in 214 patients (age, 57±13 years [mean±SD]) at 2 to 7
days after AMI. Coronary angiography was performed in 193 patients.
Follow-up data regarding major cardiac events were obtained through
telephone interviews and chart reviews. All patients were followed
for 
500 days or until a hard cardiac event occurred. The mean
follow-up interval was 494±182 days after AMI. Peak heart rate and
systolic blood pressure were 115±21 bpm and 135±29 mm Hg,
respectively. An adverse outcome occurred in 80 of 214 patients;
cardiac death occurred in 15, nonfatal AMI occurred in 15, sustained or
symptomatic ventricular arrhythmia occurred in 5, congestive heart
failure occurred in 14, and unstable angina occurred in 31. Significant
predictors of adverse outcome by univariate analysis were prior
myocardial infarction (P=.005), anterior infarction
(P=.006), multivessel coronary artery disease
(P<.0001), global resting left ventricular wall motion
score index (P<.0001), infarction zone nonviability based
on akinesis unresponsive to low-dose dobutamine (P<.0001),
and ischemia/infarction at a distance (P<.0001).
Furthermore, the extent of infarct zone and nonviability correlated
with the severity of the cardiac event. Multivariate analysis of
clinical, angiographic, and DSE variables revealed that the only
independent predictors of adverse outcome were
ischemia/infarction at a distance (P<.0001) and
infarction zone nonviability (P<.0001). Multivessel disease
identified through DSE was more predictive of adverse outcome than was
angiographically determined multivessel disease.
Conclusions DSE can be used to predict adverse outcomes after AMI.
Key Words: myocardial infarction • prognosis • stress • echocardiography
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