Open AccessWall Motion Abnormalities with Low‐Dose Dobutamine Predict a High Risk of Cardiac Death in Medically Treated Patients with Ischemic Cardiomyopathy
Author(s) -
Maskoun Waddah,
Mustafa Nowwar,
Mahenthiran Jothiharan,
GradusPizlo Irmina,
Kamalesh Masoor,
Feigenbaum Harvey,
Sawada Stephen G.
Publication year - 2009
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.20558
Subject(s) - medicine , ejection fraction , cardiology , dobutamine , hazard ratio , cardiomyopathy , coronary artery disease , heart failure , ischemic cardiomyopathy , ischemia , diabetes mellitus , confidence interval , hemodynamics , endocrinology
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.