A clinical and echocardiographic score for assigning risk of major events after dobutamine echocardiograms

Thomas H. Marwick, Colin Case, Don Poldermans, Eric Boersma, Jeroen Bax, Stephen Sawada, James D. Thomas

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Objectives We sought to develop and validate a risk score combining both clinical and dobutamine echocardiographic (DbE) features in 4,890 patients who underwent DbE at three expert laboratories and were followed for death or myocardial infarction for up to five years. Background In contrast to exercise scores, no score exists to combine clinical, stress, and echocardiographic findings with DbE. Methods Dobutamine echocardiography was performed for evaluation of known or suspected coronary artery disease in 3,156 patients at two sites in the U.S. After exclusion of patients with incomplete follow-up, 1,456 DbEs were randomly selected to develop a multivariate model for prediction of events. After simplification of each model for clinical use, the models were internally validated in the remaining DbE patients in the same series and externally validated in 1,733 patients in an independent series. Results The following score was derived from regression models in the modeling group (160 events): DbE risk = (age·0.02) + (heart failure + rate-pressure product <15,000)·0.4 + (ischemia + scar)·0.6. The presence of each variable was scored as 1 and its absence scored as 0, except for age (continuous variable). Using cutoff values of 1.2 and 2.6, patients were classified into groups with five-year event-free survivals >95%, 75% to 95%, and <75%. Application of the score in the internal validation group (265 events) gave equivalent results, as did its application in the external validation group (494 events, C index = 0.72). Conclusions A risk score based on clinical and echocardiographic data may be used to quantify the risk of events in patients undergoing DbE.

Original languageEnglish
Pages (from-to)2102-2107
Number of pages6
JournalJournal of the American College of Cardiology
Volume43
Issue number11
DOIs
StatePublished - Jun 2 2004

Fingerprint

Dobutamine
Echocardiography
Coronary Artery Disease
Heart Failure
Heart Rate
Myocardial Infarction
Exercise
Pressure

Keywords

  • CAD
  • coronary artery disease
  • DbE
  • dobutamine echocardiography/echocardiogram
  • ECG
  • electrocardiogram/electrocardiographic
  • left ventricular
  • LV
  • MI
  • myocardial infarction

ASJC Scopus subject areas

  • Nursing(all)

Cite this

A clinical and echocardiographic score for assigning risk of major events after dobutamine echocardiograms. / Marwick, Thomas H.; Case, Colin; Poldermans, Don; Boersma, Eric; Bax, Jeroen; Sawada, Stephen; Thomas, James D.

In: Journal of the American College of Cardiology, Vol. 43, No. 11, 02.06.2004, p. 2102-2107.

Research output: Contribution to journalArticle

Marwick, Thomas H. ; Case, Colin ; Poldermans, Don ; Boersma, Eric ; Bax, Jeroen ; Sawada, Stephen ; Thomas, James D. / A clinical and echocardiographic score for assigning risk of major events after dobutamine echocardiograms. In: Journal of the American College of Cardiology. 2004 ; Vol. 43, No. 11. pp. 2102-2107.
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abstract = "Objectives We sought to develop and validate a risk score combining both clinical and dobutamine echocardiographic (DbE) features in 4,890 patients who underwent DbE at three expert laboratories and were followed for death or myocardial infarction for up to five years. Background In contrast to exercise scores, no score exists to combine clinical, stress, and echocardiographic findings with DbE. Methods Dobutamine echocardiography was performed for evaluation of known or suspected coronary artery disease in 3,156 patients at two sites in the U.S. After exclusion of patients with incomplete follow-up, 1,456 DbEs were randomly selected to develop a multivariate model for prediction of events. After simplification of each model for clinical use, the models were internally validated in the remaining DbE patients in the same series and externally validated in 1,733 patients in an independent series. Results The following score was derived from regression models in the modeling group (160 events): DbE risk = (age·0.02) + (heart failure + rate-pressure product <15,000)·0.4 + (ischemia + scar)·0.6. The presence of each variable was scored as 1 and its absence scored as 0, except for age (continuous variable). Using cutoff values of 1.2 and 2.6, patients were classified into groups with five-year event-free survivals >95{\%}, 75{\%} to 95{\%}, and <75{\%}. Application of the score in the internal validation group (265 events) gave equivalent results, as did its application in the external validation group (494 events, C index = 0.72). Conclusions A risk score based on clinical and echocardiographic data may be used to quantify the risk of events in patients undergoing DbE.",
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N2 - Objectives We sought to develop and validate a risk score combining both clinical and dobutamine echocardiographic (DbE) features in 4,890 patients who underwent DbE at three expert laboratories and were followed for death or myocardial infarction for up to five years. Background In contrast to exercise scores, no score exists to combine clinical, stress, and echocardiographic findings with DbE. Methods Dobutamine echocardiography was performed for evaluation of known or suspected coronary artery disease in 3,156 patients at two sites in the U.S. After exclusion of patients with incomplete follow-up, 1,456 DbEs were randomly selected to develop a multivariate model for prediction of events. After simplification of each model for clinical use, the models were internally validated in the remaining DbE patients in the same series and externally validated in 1,733 patients in an independent series. Results The following score was derived from regression models in the modeling group (160 events): DbE risk = (age·0.02) + (heart failure + rate-pressure product <15,000)·0.4 + (ischemia + scar)·0.6. The presence of each variable was scored as 1 and its absence scored as 0, except for age (continuous variable). Using cutoff values of 1.2 and 2.6, patients were classified into groups with five-year event-free survivals >95%, 75% to 95%, and <75%. Application of the score in the internal validation group (265 events) gave equivalent results, as did its application in the external validation group (494 events, C index = 0.72). Conclusions A risk score based on clinical and echocardiographic data may be used to quantify the risk of events in patients undergoing DbE.

AB - Objectives We sought to develop and validate a risk score combining both clinical and dobutamine echocardiographic (DbE) features in 4,890 patients who underwent DbE at three expert laboratories and were followed for death or myocardial infarction for up to five years. Background In contrast to exercise scores, no score exists to combine clinical, stress, and echocardiographic findings with DbE. Methods Dobutamine echocardiography was performed for evaluation of known or suspected coronary artery disease in 3,156 patients at two sites in the U.S. After exclusion of patients with incomplete follow-up, 1,456 DbEs were randomly selected to develop a multivariate model for prediction of events. After simplification of each model for clinical use, the models were internally validated in the remaining DbE patients in the same series and externally validated in 1,733 patients in an independent series. Results The following score was derived from regression models in the modeling group (160 events): DbE risk = (age·0.02) + (heart failure + rate-pressure product <15,000)·0.4 + (ischemia + scar)·0.6. The presence of each variable was scored as 1 and its absence scored as 0, except for age (continuous variable). Using cutoff values of 1.2 and 2.6, patients were classified into groups with five-year event-free survivals >95%, 75% to 95%, and <75%. Application of the score in the internal validation group (265 events) gave equivalent results, as did its application in the external validation group (494 events, C index = 0.72). Conclusions A risk score based on clinical and echocardiographic data may be used to quantify the risk of events in patients undergoing DbE.

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KW - MI

KW - myocardial infarction

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