Significance of hypotensive response during dobutamine stress echocardiography

• Published in: International journal of cardiology 2008-04, Vol.125 (3), p.358-363
• Main Authors: Dunkelgrun, Martin, Hoeks, Sanne E, Elhendy, Abdou, van Domburg, Ron T, Bax, Jeroen J, Noordzij, Peter G, Feringa, Harm H.H, Vidakovic, Radosav, Karagiannis, Stefanos E, Schouten, Olaf, Poldermans, Don
• Format: Article
• Language: English
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Age Factors; Beta-blocker, Prognosis; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Cardiovascular system; Coronary Artery Disease - mortality; Dobutamine stress echocardiography; Echocardiography, Stress; Female; Follow-Up Studies; Humans; Hypertension - drug therapy; Hypertension - epidemiology; Hypotension - epidemiology; Hypotensive response; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Mortality; Myocardial Infarction - epidemiology; Prognosis; Severity of Illness Index; Ultrasonic investigative techniques
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2007.02.058

Abstract 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.