Abstract 10745: Dobutamine Stress Echocardiography Predicts Cardiac Events but Not Total Mortality In Octogenarian Patients Referred with Suspected Cardiac Chest Pain
Background - The prognostic significance of dobutamine stress echocardiography (DSE) in octogenarians remains unclear despite increasing referrals. This study aimed to investigate whether DSE predicts total mortality and cardiac events in octogenarians.
Methods - Five hundred and fifty consecutive octogenarians (mean age 84 ± 3.7 years) with suspected cardiac chest pain had DSE. A positive result was defined as a new or worsening wall motion score in 1 or more left ventricular (LV) segments. Demographic, baseline, and peak DSE data were collected. Total mortality and cardiac events (cardiac mortality and non-fatal myocardial infarction) were prospectively analyzed.
Results - DSE was successfully completed in all patients with no adverse outcomes. One hundred and eighty three (33%) patients had a positive DSE result, 271 (49%) had a normal study, and 96 (18%) had fixed wall motion abnormalities. During a mean follow up of 2.1 ± 1.1 years, there were 217 (40%) cardiac events and 63 (12%) deaths, of which 46 (73%) were cardiac. A positive DSE result was associated with significantly increased cardiac events (p < 0.001) but not total mortality. Patients with cardiac events had significantly lower LV ejection fraction (38 ± 3% vs 48 ± 5%, p < 0.001), higher proportion with a baseline wall motion abnormality (62% vs 28%, p = 0.04), higher proportion with a positive DSE result (68% vs 21%, p = 0.002), higher peak wall motion score index (1.3 ± 0.9 vs 1.1 ± 0.3, p = 0.001) and higher diastolic BP (78 ± 25 mmHg vs 67 ± 16 mmHg, p = 0.004). There were no significant differences with regards to age, gender, past history or family history of cardiac disease, smoking, cholesterol, diabetes, systolic BP, NYHA class, medication, previous revascularization, LV wall thickness and left atrial size. With multivariate regression analysis, a positive DSE result (p = 0.001, Exp(B) 1.6, 95% CI 0.79-1.51) and diastolic BP (p = 0.007, Exp(B) 1.98, 95% CI 0.97-0.99) were the only independent predictors of a cardiac event.
Conclusion - DSE predicts cardiac events but not total mortality in octogenarians with suspected cardiac chest pain. The test is safe and well tolerated. A positive DSE result and diastolic BP were the only independent predictors of cardiac events.
- © 2011 by American Heart Association, Inc.