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

Abstract

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.

Guidelines for Performance, Interpretation, and Application of Stress Echocardiography in Ischemic Heart Disease: From the American Society of Echocardiography

“…These segments are partially viable, have severely reduced perfusion reserve, and are associated with severe, multivessel coronary artery obstruction, reduced collateral supply, and increased cardiac mortality. 51,238 d. Accuracy of DSE for Detection of Viability Numerous studies have shown that low dose or combined low and high dose dobutamine infusion protocols have clinically useful sensitivity (75 to 80%) and specificity (80 to 85%) for identification of viable segments with functional recovery after revascularization. 22,239,240 False-negative exams may occur in hibernating regions with disrupted contractile proteins that cannot respond to dobutamine but eventually manifest functional recovery months after revascularization, with reorganization of contractile proteins.…”

Management of anterior ST-elevation myocardial infarction presenting more than 48 hours from symptom onset without reperfusion therapy in the cardiac care unit

“…The sensitivity and specificity of the DSE range vary between 71-97% and 63-95%, respectively (Maskoun et al, 2009).…”

ACR Appropriateness Criteria® Suspected New-Onset and Known Nonacute Heart Failure

“…Stress. Several studies have demonstrated the utility of stress echocardiography to identify both resting and poststress systolic wall motion abnormalities [90][91][92]. Additionally, these findings correlate to clinical outcomes.…”