Stress‐Induced Wall Motion Abnormalities with Low‐Dose Dobutamine Infusion Indicate the Presence of Severe Disease and Vulnerable Myocardium

Sawada, Stephen; Safadi, Anas; Gaitonde, Shivani; Tung, Nisha; Mahenthiran, Jothiharan; Gill, William J.; Ghumman, Waqas; Gradus‐Pizlo, Irmina; Kamalesh, Masoor; Fineberg, Naomi S.; Feigenbaum, Harvey

doi:10.1111/j.1540-8175.2007.00471.x

Cited by 16 publications

(3 citation statements)

References 18 publications

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“…We have previously shown that stress-induced wall motion abnormalities (SWMA) with low-dose dobutamine occur in the presence of severe and extensive coronary disease suggesting that low-dose SWMA is due to ischemia. 3 We have also shown that low-dose SWMA most frequently occurs in segments with resting wall motion abnormalities. These segments may represent repetitively stunned or hibernating myocardium.…”

Section: Introductionmentioning

confidence: 65%

“…In a previous investigation, evaluating a similar population of patients, we found that the multivessel disease was the strongest independent predictor of lowdose ischemia. 3 Afridi et al and Cornel et al have reported a lower incidence of ischemia with low-dose dobutamine. 10 -11 Unlike our study, these investigations did not assess for ischemia in segments with normal wall motion at rest.…”

Section: Discussionmentioning

confidence: 93%

“…We have previously shown that low-dose SWMA indicates the presence of severe and extensive CAD, and reduced collateral supply. 3 In our prior study, patients with low-dose SWMA had nearly a 100% frequency of multivessel disease indicating that low-dose SWMA is a marker for patients with high risk coronary anatomy. The finding that lowdose SWMA is also an indicator of a poor prognosis is not unexpected given the relationship of low-dose SWMA to severe and extensive CAD.…”

Section: Low-dose Swma and Cardiac Deathmentioning

confidence: 89%

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Wall Motion Abnormalities with Low‐Dose Dobutamine Predict a High Risk of Cardiac Death in Medically Treated Patients with Ischemic Cardiomyopathy

Maskoun

Mustafa

Mahenthiran

et al. 2009

Clinical Cardiology

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Background Severe and extensive coronary artery disease is the underlying cause of stress‐induced wall motion abnormalities (SWMA) with low‐dose (10 µg/kg/min) dobutamine suggesting that these abnormalities may identify those with poor outcome. Hypothesis We assessed the prognostic value of low‐dose SWMA in medically treated patients with ischemic cardiomyopathy. Methods Low‐ and peak‐dose dobutamine echocardiography was performed in 235 patients with ischemic cardiomyopathy (ejection fraction 31% ± 8%) who were treated with medical therapy. The survival of patients with low‐dose SWMA (n = 33) was compared with the survival of patients without ischemia (n = 85) and those with peak‐dose SWMA (n = 117). Results There were 123 cardiac deaths (52%) during follow‐up of 4.1 ± 3.3 years. Multivariate predictors of cardiac death were age (p = 0.002, hazard ratio [HR]: 1.03), diabetes (p = 0.028, HR: 1.54), New York Heart Association (NYHA) class III, IV heart failure (p = 0.001, HR: 1.94), the presence of peak dose SWMA (p < 0.001, HR: 2.59), and low‐dose SWMA (p = 0.005, HR: 2.28). Survival of patients without ischemia was significantly better than those with peak‐dose SWMA (p < 0.0001) and those with low‐dose SWMA (p = 0.001). The survival of patients with low‐dose SWMA was the same as those with peak‐dose SWMA (p = 0.89). Conclusions Low‐dose SWMA is an independent predictor of cardiac mortality in medically treated patients with ischemic cardiomyopathy. Patients with low‐dose SWMA are at equivalent risk to those with peak‐dose SWMA. Copyright © 2009 Wiley Periodicals, Inc.

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Section: Introductionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 93%

Section: Low-dose Swma and Cardiac Deathmentioning

confidence: 89%

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Wall Motion Abnormalities with Low‐Dose Dobutamine Predict a High Risk of Cardiac Death in Medically Treated Patients with Ischemic Cardiomyopathy

Maskoun

Mustafa

Mahenthiran

et al. 2009

Clinical Cardiology

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Echocardiography Evaluation of Ischemic Heart Disease

Boccellino

Agricola

2023

Ischemic Heart Disease

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The elusive role of myocardial perfusion imaging in stable ischemic heart disease: Is ISCHEMIA the answer?

Xie

Winchester

Phillips

et al. 2017

Journal of Nuclear Cardiology

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The assessment of ischemia through myocardial perfusion imaging (MPI) is widely accepted as an index step in the diagnostic evaluation of stable ischemic heart disease (SIHD). Numerous observational studies have characterized the prognostic significance of ischemia extent and severity. However, the role of ischemia in directing downstream SIHD care including coronary revascularization has remained elusive as reductions in ischemic burden have not translated to improved clinical outcomes in randomized trials. Importantly, selection bias leading to the inclusion of many low risk patients with minimal ischemia have narrowed the generalizability of prior studies along with other limitations. Accordingly, an ongoing randomized controlled trial entitled ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) will compare an invasive coronary revascularization strategy vs a conservative medical therapy approach among stable patients with moderate to severe ischemia. The results of ISCHEMIA may have a substantial impact on the management of SIHD and better define the role of MPI in current SIHD pathways of care.

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Stress‐Induced Wall Motion Abnormalities with Low‐Dose Dobutamine Infusion Indicate the Presence of Severe Disease and Vulnerable Myocardium

Abstract: In patients with ischemic LV systolic dysfunction, the extent of severe disease and a lower numbers of collaterals predict the occurrence of low-dose SWMA. Low-dose SWMA is a highly specific marker for severe disease.

Cited by 16 publications

References 18 publications

Wall Motion Abnormalities with Low‐Dose Dobutamine Predict a High Risk of Cardiac Death in Medically Treated Patients with Ischemic Cardiomyopathy

Wall Motion Abnormalities with Low‐Dose Dobutamine Predict a High Risk of Cardiac Death in Medically Treated Patients with Ischemic Cardiomyopathy

Echocardiography Evaluation of Ischemic Heart Disease

The elusive role of myocardial perfusion imaging in stable ischemic heart disease: Is ISCHEMIA the answer?

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