Abstract 2342: Severe Hypotension During Dobutamine Stress Echocardiography is Associated With Adverse Long Term Cardiac Outcome While Beta-Blockers Have a Beneficial Effect in This Population
Background: Dobutamine stress echocardiography (DSE) is used for the detection of coronary artery disease. Commonly, blood pressure remains unchanged.
Objective: To assess the prognostic value of hypotension during DSE and the benificial effect of beta-blockers (BBL).
Methods: 3381 patients (68% male, age 61 ± 13 yrs) underwent DSE. Blood pressure was measured at every dose-step. A hypotensive response was defined as mild (systolic blood pressure drop of 0 –20 mmHg) or severe (systolic blood pressure drop of ≥20 mmHg). DSE results were scored for the presence of ischemia using a 16-segment, 5-point scale. During follow up cardiac death (CD) and myocardial infarction (MI) were noted. Multivariate Cox proportional hazard regression analysis was used to evaluate the prognostic value of mild and severe hypotension during DSE and the effect of BBL.
Results: Mild and severe hypotension during DSE occurred in 936 (28%) and 521 (15%) patients, respectively. During a mean follow up of 4.5 years (± 3.3 SD), 555 patients experienced CD and 158 a MI. Kaplan-Meier survival curves showed a significantly decreased survival in those with severe hypotension and mild hypotension. After adjustment for clinical characteristics and DSE results only severe hypotension was associated with increased incidence of late CD and MI (HR: 1.3, 95% CI: 1.1–1.7). Importantly, in these patients BBL use was associated with an improved outcome (HR:0.7, 95% CI: 0.5– 0.9).
Conclusion: Severe hypotension during dobutamine stress echocardiography independantly predicts cardiac death and hard cardiac events and may improve the predictive value of cardiac testing. BBL use improved outcome in these patients.