Wall motion abnormalities with low-dose dobutamine predict a high risk of cardiac death in medically treated patients with ischemic cardiomyopathy

Waddah Maskoun, Nowwar Mustafa, Jothiharan Mahenthiran, Irmina Gradus-Pizlo, Masoor Kamalesh, Harvey Feigenbaum, Stephen G. Sawada

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)403-409
Number of pages7
JournalClinical cardiology
Volume32
Issue number7
DOIs
StatePublished - Jul 2009

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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