Prognostic Significance of Myocardial Ischemia by Dobutamine Stress Echocardiography in Patients Without Angina Pectoris After Coronary Revascularization

      The clinical utility of stress testing in patients without angina pectoris after revascularization has been questioned. Dobutamine stress echocardiography (DSE) is an established technique for detection of myocardial ischemia and cardiac risk stratification. We studied the prognostic value of DSE in 393 patients without typical angina pectoris after coronary revascularization. Ischemia was incremental to clinical data in predicting all-cause death (hazard ratio 3.5, 95% confidence interval 1.8 to 6.7) and cardiac death (hazard ratio 4.2, 95% confidence interval 1.8 to 9.8). In conclusion, myocardial ischemia during DSE is independently associated with an increased risk of all-cause mortality and cardiac death in these patients after adjustment for clinical data.
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        • Gibbons R.J.
        • Balady G.J.
        • Bricker J.T.
        • Chaitman B.R.
        • Fletcher G.F.
        • Froelicher V.F.
        • Mark D.B.
        • McCallister B.D.
        • Mooss A.N.
        • O'Reilly M.G.
        • et al.
        American College of Cardiology/American Heart Association Task Force on Practice Guidelines. ACC/AHA 2002 guideline update for exercise testing: a report of the American College of Cardiology/American College Association Task Force on Practice Guidelines.
        Circulation. 2002; 106: 1883-1892
        • Ritchie J.L.
        • Bateman T.M.
        • Bonow R.O.
        • Crawford M.H.
        • Gibbons R.J.
        • Hall R.J.
        • O'Rourke R.A.
        • Parisi A.F.
        • Verani M.S.
        Guidelines for clinical use of cardiac radionuclide imaging: a report of the American College of Cardiology/American College Association Task Force on Practice Guidelines on assessment of diagnostic and therapeutic cardiovascular procedure, committee on radionuclide imaging, developed in collaboration with the American Society of Nuclear Cardiology.
        J Am Coll Cardiol. 1995; 25: 521-527
        • Brindis R.G.
        • Douglas P.S.
        • Hendel R.C.
        • Peterson E.D.
        • Wolk M.J.
        • Allen J.M.
        • Patel M.R.
        • Raskin I.E.
        • Hendel R.C.
        • Bateman T.M.
        • et al.
        • American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group; American Society of Nuclear Cardiology; American Heart Association
        ACCF/ASNC appropriateness criteria for single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI): A report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group and the American Society of Nuclear Cardiology endorsed by the American Heart Association.
        J Am Coll Cardiol. 2005; 46: 1587-1605
        • Poldermans D.
        • Fioretti P.M.
        • Boersma E.
        • Bax J.J.
        • Thomson I.R.
        • Roelandt J.R.
        • Simoons M.L.
        Long-term prognostic value of dobutamine-atropine stress echocardiography in 1737 patients with known or suspected coronary artery disease: a single-center experience.
        Circulation. 1999; 99: 757-762
        • Stettler C.
        • Wandel S.
        • Allemann S.
        • Kastrati A.
        • Morice M.C.
        • Schömig A.
        • Pfisterer M.E.
        • Stone G.W.
        • Leon M.B.
        • de Lezo J.S.
        • et al.
        Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis.
        Lancet. 2007; 370: 937-948
        • Goldman S.
        • Zadina K.
        • Moritz T.
        • Ovitt T.
        • Sethi G.
        • Copeland J.G.
        • Thottapurathu L.
        • Krasnicka B.
        • Ellis N.
        • Anderson R.J.
        • Henderson W.
        • et al.
        • VA Cooperative Study Group
        Long-term patency of saphenous vein and left internal mammary artery grafts after coronary bypass surgery: Results from a Department of Veterans Affairs Cooperative Study.
        J Am Coll Cardiol. 2004; 44: 2149-2156
        • Lauer M.S.
        • Lytle B.
        • Pashkow F.
        • Snader C.E.
        • Marwick T.H.
        Prediction of death and myocardial infarction by screening with exercise-thallium testing after coronary-artery-bypass grafting.
        Lancet. 1998; 351: 615-622
        • Elhendy A.
        • Schinkel A.F.L.
        • van Domburg R.T.
        • JJ Bax
        • Valkema R.
        • Poldermans D.
        Risk stratification of patients after myocardial revascularization by stress Tc-99m tetrofosmin myocardial perfusion tomography.
        J Nucl Cardiol. 2003; 10: 615-622
        • Zhang X.
        • Liu X.
        • He Z.X.
        • Shi R.
        • Yang M.
        • Gao R.
        • Chen J.
        • Yang Y.
        • Fang W.
        Long term prognostic value of exercise 99m MIBI SPET myocardial perfusion imaging in patients after percutaneous coronary intervention.
        Eur J Nucl Med Mol Imaging. 2004; 31: 655-662
        • Bountioukos M.
        • Elhendy A.
        • van Domburg R.T.
        • Schinkel A.F.
        • Bax J.J.
        • Krenning B.J.
        • Biagini E.
        • Rizzello V.
        • Simoons M.L.
        • Poldermans D.
        Prognostic value of dobutamine stress echocardiography in patients with previous coronary revascularization.
        Heart. 2004; 90: 1031-1035
        • Feringa H.H.
        • Karagiannis S.E.
        • Vidakovic R.
        • Elhendy A.
        • ten Cate F.J.
        • Noordzij P.G.
        • van Domburg R.T.
        • Bax J.J.
        • Poldermans D.
        The prevalence and prognosis of unrecognized myocardial infarction and silent myocardial ischemia in patients undergoing major vascular surgery.
        Coron Artery Dis. 2007; 18: 571-576