Does the prognostic value of dobutamine stress echocardiography differ among different age groups?

Abstract

BACKGROUND:

Age is associated with reduced exercise capacity and greater prevalence of coronary artery disease. Whether the prognostic information obtained from dobutamine stress echocardiography (DSE), a stress test commonly used for patients unable to perform an exercise test, provides differential information based on age is not well known.

METHODS:

We studied 6,655 consecutive patients referred for DSE. Patients were divided into 3 age groups: (1) <60 years (n = 1,389), (2) 60 to 74 years (n = 2,978), and (3) ≥75 years (n = 2,288). Mean follow-up was 5.5 ± 2.8 years. End points included all-cause mortality and cardiac events, including myocardial infarction and late (>3 months) coronary revascularization.

RESULTS:

Peak stress wall motion score index was an independent predictor of cardiac events in all age groups (<60 years: hazard ratio [HR] 1.14, P = .02; 60-74 years: HR 1.70, P < .0001; ≥75 years: HR 1.10, P = .006). In patients ≥75 years, peak wall motion score index (HR 1.10, P < .0001) and abnormal left ventricular end-systolic volume response (HR 1.25, P = .03) were independent predictors of death. In patients aged 60 to 74 years, abnormal left ventricular end-systolic volume response (HR 1.43, P = .0003) was independently related to death, whereas in patients <60 years, the echocardiographic data assessed during stress were not a predictor.

CONCLUSIONS:

Dobutamine stress echocardiography provided independent information predictive of cardiac events among all age groups and death in patients ≥60 years. However, among patients <60 years, stress-induced echocardiographic abnormalities were not independently associated with mortality. Comorbidities, which have precluded exercise testing, may be most relevant in predicting mortality in patients <60 years undergoing DSE.

• Authors: Alain M Bernheim, Maytinee Kittipovanonth, Paul Y Takahashi, S Michael Gharacholou, Christopher G Scott, Patricia A Pellikka
• Journal: American heart journal (Am Heart J) Vol. 161 Issue 4 Pg. 740-5 (Apr 2011) ISSN: 1097-6744 [Electronic] United States
• PMID: 21473974 (Publication Type: Comparative Study, Evaluation Study, Journal Article)
• Copyright: Copyright © 2011 Mosby, Inc. All rights reserved.

Topics

• Age Factors
• Aged
• Coronary Artery Disease (diagnostic imaging)
• Echocardiography, Stress
• Female
• Humans
• Male
• Middle Aged
• Predictive Value of Tests
• Prognosis