Cited 6 times since 2007 (0.4 per year) source: EuropePMC International journal of cardiology, Volume 125, Issue 3, 26 4 2007, Pages 358-363 Significance of hypotensive response during dobutamine stress echocardiography. Dunkelgrun M, Hoeks SE, Elhendy A, van Domburg RT, Bax JJ, Noordzij PG, Feringa HH, Vidakovic R, Karagiannis SE, Schouten O, Poldermans D
Background
In patients undergoing exercise testing a hypotensive response is associated with a poor prognosis. There is limited information regarding the prognostic significance of hypotension during dobutamine stress test. This study investigates the association between a severe hypotensive response during DSE and long-term prognosis.
Methods
Patients (3381) underwent dobutamine stress echocardiography (DSE). Blood pressure was measured automatically at rest and at the end of every dose-step. Wall motion was scored using a 16-segement, 5-point score. Ischemia was defined by the presence of new wall motion abnormalities. Hypotensive response during DSE was defined as mild (MHR) when systolic blood pressure (SBP) dropped <20 mmHg between rest and peak stress, and severe (SHR) when SBP dropped <20 mmHg. During follow-up all cause mortality and MACE (cardiac death or non-fatal myocardial infarction) were noted.
Results
MHR and SHR occurred in 936 (28%) and 521 (15%) patients, respectively. Independent predictors of SHR were older age, new or worsening wall motion abnormalities and history of hypertension. During follow-up of 4.5 (+/-3.3) years, 920 patients died, of which 555 due to cardiac causes, and 713 patients experienced a MACE. After adjustment for baseline characteristics and DSE results SHR during DSE was independently associated with increased long-term cardiac death (HR: 1.3, 95% CI: 1.03-1.6) and MACE (HR: 1.34, 95% CI: 1.1-1.6), while MHR was not associated with a worse outcome.
Conclusions
Severe hypotensive response during DSE independently predicts cardiac death and MACE in patients with known or suspected coronary artery disease.
