Prognostic Significance of Akinesis Becoming Dyskinesis During Dobutamine Stress Echocardiography
Background Akinesis becoming dyskinesis (AKBD) at high-dose dobutamine stress echocardiography (DSE) has been disregarded as a marker of myocardial ischemia. However, its prognostic significance is unknown. Objectives We sought to assess the long-term outcome of patients with AKBD during DSE. Method...
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| Veröffentlicht in: | Journal of the American Society of Echocardiography 2007-03, Vol.20 (3), p.257-261 |
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| creator | Sozzi, Fabiola B., MD Elhendy, Abdou, MD Rizzello, Vittoria, MD Biagini, Elena, MD van Domburg, Ron T., PhD Vourvouri, Eleni C., MD Schinkel, Arend F.L., MD Battista Danzi, Gian, MD Bax, Jeroen J., MD Poldermans, Don, MD, PhD |
| description | Background Akinesis becoming dyskinesis (AKBD) at high-dose dobutamine stress echocardiography (DSE) has been disregarded as a marker of myocardial ischemia. However, its prognostic significance is unknown. Objectives We sought to assess the long-term outcome of patients with AKBD during DSE. Methods A total of 731 patients (age 62 ± 15 years, 628 men) with two or more akinetic left ventricular segments at rest underwent DSE and were followed up for a mean period of 5 ± 2.7 years. The end points considered during follow-up were hard cardiac events (cardiac death and nonfatal myocardial infarction) and heart failure. Results Dyskinesis in two or more segments at peak stress developed in 60 patients (8%). Resting wall-motion score index was 2.6 ± 0.56 in patients with AKBD versus 2.3 ± 0.55 in patients without AKBD ( P = .0002). Ischemia occurred in 197 patients (27%). During follow-up, 254 patients (35%) developed hard cardiac events and 204 patients (28%) developed heart failure. In all, 226 patients (31%) died of various causes (cardiac death in 172 patients). The annualized hard cardiac event rate was 11% in patients with AKBD and 6% in patients without ( P = .03). The incidence of heart failure was significantly higher in patients with AKBD than without (47% vs 26%, P < .001). Independent predictors of hard cardiac events were age (hazard ratio [HR] 1.03 [confidence interval {CI} = 1.01-1.04]), previous myocardial infarction (HR 1.4 [CI = 1.1-1.9]), diabetes mellitus (HR 1.8 [CI = 1.3-2.5]), resting wall-motion score index (HR 1.11 [CI = 1.01-1.04]), and AKBD (HR 1.6 [CI = 1.1-2.4]). Conclusion AKBD at peak DSE is associated with increased risk of cardiac events in patients with akinetic segments at baseline echocardiogram. |
| doi_str_mv | 10.1016/j.echo.2006.08.043 |
| format | Article |
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However, its prognostic significance is unknown. Objectives We sought to assess the long-term outcome of patients with AKBD during DSE. Methods A total of 731 patients (age 62 ± 15 years, 628 men) with two or more akinetic left ventricular segments at rest underwent DSE and were followed up for a mean period of 5 ± 2.7 years. The end points considered during follow-up were hard cardiac events (cardiac death and nonfatal myocardial infarction) and heart failure. Results Dyskinesis in two or more segments at peak stress developed in 60 patients (8%). Resting wall-motion score index was 2.6 ± 0.56 in patients with AKBD versus 2.3 ± 0.55 in patients without AKBD ( P = .0002). Ischemia occurred in 197 patients (27%). During follow-up, 254 patients (35%) developed hard cardiac events and 204 patients (28%) developed heart failure. In all, 226 patients (31%) died of various causes (cardiac death in 172 patients). The annualized hard cardiac event rate was 11% in patients with AKBD and 6% in patients without ( P = .03). The incidence of heart failure was significantly higher in patients with AKBD than without (47% vs 26%, P < .001). Independent predictors of hard cardiac events were age (hazard ratio [HR] 1.03 [confidence interval {CI} = 1.01-1.04]), previous myocardial infarction (HR 1.4 [CI = 1.1-1.9]), diabetes mellitus (HR 1.8 [CI = 1.3-2.5]), resting wall-motion score index (HR 1.11 [CI = 1.01-1.04]), and AKBD (HR 1.6 [CI = 1.1-2.4]). Conclusion AKBD at peak DSE is associated with increased risk of cardiac events in patients with akinetic segments at baseline echocardiogram.</description><identifier>ISSN: 0894-7317</identifier><identifier>EISSN: 1097-6795</identifier><identifier>DOI: 10.1016/j.echo.2006.08.043</identifier><identifier>PMID: 17336751</identifier><language>eng</language><publisher>United States: Mosby, Inc</publisher><subject>Cardiovascular ; Cohort Studies ; Comorbidity ; Coronary Artery Disease - diagnostic imaging ; Coronary Artery Disease - mortality ; Dobutamine ; Echocardiography, Stress - statistics & numerical data ; Humans ; Incidence ; Italy - epidemiology ; Male ; Middle Aged ; Myocardial Ischemia - diagnostic imaging ; Myocardial Ischemia - mortality ; Prevalence ; Prognosis ; Reproducibility of Results ; Risk Assessment - methods ; Risk Factors ; Sensitivity and Specificity ; Survival Analysis ; Survival Rate ; Ventricular Dysfunction, Left - diagnostic imaging ; Ventricular Dysfunction, Left - mortality</subject><ispartof>Journal of the American Society of Echocardiography, 2007-03, Vol.20 (3), p.257-261</ispartof><rights>American Society of Echocardiography</rights><rights>2007 American Society of Echocardiography</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c409t-8a9160457f13833dcbdffeb22d647631df9303c355bbec9575724266830dc2c73</citedby><cites>FETCH-LOGICAL-c409t-8a9160457f13833dcbdffeb22d647631df9303c355bbec9575724266830dc2c73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0894731706009084$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17336751$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sozzi, Fabiola B., MD</creatorcontrib><creatorcontrib>Elhendy, Abdou, MD</creatorcontrib><creatorcontrib>Rizzello, Vittoria, MD</creatorcontrib><creatorcontrib>Biagini, Elena, MD</creatorcontrib><creatorcontrib>van Domburg, Ron T., PhD</creatorcontrib><creatorcontrib>Vourvouri, Eleni C., MD</creatorcontrib><creatorcontrib>Schinkel, Arend F.L., MD</creatorcontrib><creatorcontrib>Battista Danzi, Gian, MD</creatorcontrib><creatorcontrib>Bax, Jeroen J., MD</creatorcontrib><creatorcontrib>Poldermans, Don, MD, PhD</creatorcontrib><title>Prognostic Significance of Akinesis Becoming Dyskinesis During Dobutamine Stress Echocardiography</title><title>Journal of the American Society of Echocardiography</title><addtitle>J Am Soc Echocardiogr</addtitle><description>Background Akinesis becoming dyskinesis (AKBD) at high-dose dobutamine stress echocardiography (DSE) has been disregarded as a marker of myocardial ischemia. However, its prognostic significance is unknown. Objectives We sought to assess the long-term outcome of patients with AKBD during DSE. Methods A total of 731 patients (age 62 ± 15 years, 628 men) with two or more akinetic left ventricular segments at rest underwent DSE and were followed up for a mean period of 5 ± 2.7 years. The end points considered during follow-up were hard cardiac events (cardiac death and nonfatal myocardial infarction) and heart failure. Results Dyskinesis in two or more segments at peak stress developed in 60 patients (8%). Resting wall-motion score index was 2.6 ± 0.56 in patients with AKBD versus 2.3 ± 0.55 in patients without AKBD ( P = .0002). Ischemia occurred in 197 patients (27%). During follow-up, 254 patients (35%) developed hard cardiac events and 204 patients (28%) developed heart failure. In all, 226 patients (31%) died of various causes (cardiac death in 172 patients). The annualized hard cardiac event rate was 11% in patients with AKBD and 6% in patients without ( P = .03). The incidence of heart failure was significantly higher in patients with AKBD than without (47% vs 26%, P < .001). Independent predictors of hard cardiac events were age (hazard ratio [HR] 1.03 [confidence interval {CI} = 1.01-1.04]), previous myocardial infarction (HR 1.4 [CI = 1.1-1.9]), diabetes mellitus (HR 1.8 [CI = 1.3-2.5]), resting wall-motion score index (HR 1.11 [CI = 1.01-1.04]), and AKBD (HR 1.6 [CI = 1.1-2.4]). Conclusion AKBD at peak DSE is associated with increased risk of cardiac events in patients with akinetic segments at baseline echocardiogram.</description><subject>Cardiovascular</subject><subject>Cohort Studies</subject><subject>Comorbidity</subject><subject>Coronary Artery Disease - diagnostic imaging</subject><subject>Coronary Artery Disease - mortality</subject><subject>Dobutamine</subject><subject>Echocardiography, Stress - statistics & numerical data</subject><subject>Humans</subject><subject>Incidence</subject><subject>Italy - epidemiology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Myocardial Ischemia - diagnostic imaging</subject><subject>Myocardial Ischemia - mortality</subject><subject>Prevalence</subject><subject>Prognosis</subject><subject>Reproducibility of Results</subject><subject>Risk Assessment - methods</subject><subject>Risk Factors</subject><subject>Sensitivity and Specificity</subject><subject>Survival Analysis</subject><subject>Survival Rate</subject><subject>Ventricular Dysfunction, Left - diagnostic imaging</subject><subject>Ventricular Dysfunction, Left - mortality</subject><issn>0894-7317</issn><issn>1097-6795</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc1q3DAUhUVoaSZJXyCL4lV3dq8kW7IhBNIk_YFAApOuhSxdTzTxWBPJLszbR-5MCXRREAiuzjlcfYeQcwoFBSq-rAs0T75gAKKAuoCSH5EFhUbmQjbVO7KAuilzyak8JicxrgGgqgE-kGMqOReyoguiH4JfDT6OzmRLtxpc54weDGa-y66e3YDRxewrGr9xwyq72cW_s5sp_Jn4dhp1esRsOQaMMbtNOxkdrPOroLdPuzPyvtN9xI-H-5T8-nb7eP0jv7v__vP66i43JTRjXuuGCigr2VFec25Na7sOW8asKKXg1HYNB254VbUtmqaSlWQlE6LmYA0zkp-Sz_vcbfAvE8ZRbVw02Pd6QD9FJYGV6cxCthea4GMM2KltcBsddoqCmsGqtZrBqhmsglolsMn06ZA-tRu0b5YDySS42Asw_fG3w6CicZhIWhfQjMp69__8y3_spndD6qJ_xh3GtZ_CkOgpqiJToJZztXOzIAAaqEv-CmODn0g</recordid><startdate>20070301</startdate><enddate>20070301</enddate><creator>Sozzi, Fabiola B., MD</creator><creator>Elhendy, Abdou, MD</creator><creator>Rizzello, Vittoria, MD</creator><creator>Biagini, Elena, MD</creator><creator>van Domburg, Ron T., PhD</creator><creator>Vourvouri, Eleni C., MD</creator><creator>Schinkel, Arend F.L., MD</creator><creator>Battista Danzi, Gian, MD</creator><creator>Bax, Jeroen J., MD</creator><creator>Poldermans, Don, MD, PhD</creator><general>Mosby, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20070301</creationdate><title>Prognostic Significance of Akinesis Becoming Dyskinesis During Dobutamine Stress Echocardiography</title><author>Sozzi, Fabiola B., MD ; Elhendy, Abdou, MD ; Rizzello, Vittoria, MD ; Biagini, Elena, MD ; van Domburg, Ron T., PhD ; Vourvouri, Eleni C., MD ; Schinkel, Arend F.L., MD ; Battista Danzi, Gian, MD ; Bax, Jeroen J., MD ; Poldermans, Don, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c409t-8a9160457f13833dcbdffeb22d647631df9303c355bbec9575724266830dc2c73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Cardiovascular</topic><topic>Cohort Studies</topic><topic>Comorbidity</topic><topic>Coronary Artery Disease - diagnostic imaging</topic><topic>Coronary Artery Disease - mortality</topic><topic>Dobutamine</topic><topic>Echocardiography, Stress - statistics & numerical data</topic><topic>Humans</topic><topic>Incidence</topic><topic>Italy - epidemiology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Myocardial Ischemia - diagnostic imaging</topic><topic>Myocardial Ischemia - mortality</topic><topic>Prevalence</topic><topic>Prognosis</topic><topic>Reproducibility of Results</topic><topic>Risk Assessment - methods</topic><topic>Risk Factors</topic><topic>Sensitivity and Specificity</topic><topic>Survival Analysis</topic><topic>Survival Rate</topic><topic>Ventricular Dysfunction, Left - diagnostic imaging</topic><topic>Ventricular Dysfunction, Left - mortality</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sozzi, Fabiola B., MD</creatorcontrib><creatorcontrib>Elhendy, Abdou, MD</creatorcontrib><creatorcontrib>Rizzello, Vittoria, MD</creatorcontrib><creatorcontrib>Biagini, Elena, MD</creatorcontrib><creatorcontrib>van Domburg, Ron T., PhD</creatorcontrib><creatorcontrib>Vourvouri, Eleni C., MD</creatorcontrib><creatorcontrib>Schinkel, Arend F.L., MD</creatorcontrib><creatorcontrib>Battista Danzi, Gian, MD</creatorcontrib><creatorcontrib>Bax, Jeroen J., MD</creatorcontrib><creatorcontrib>Poldermans, Don, MD, PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American Society of Echocardiography</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sozzi, Fabiola B., MD</au><au>Elhendy, Abdou, MD</au><au>Rizzello, Vittoria, MD</au><au>Biagini, Elena, MD</au><au>van Domburg, Ron T., PhD</au><au>Vourvouri, Eleni C., MD</au><au>Schinkel, Arend F.L., MD</au><au>Battista Danzi, Gian, MD</au><au>Bax, Jeroen J., MD</au><au>Poldermans, Don, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognostic Significance of Akinesis Becoming Dyskinesis During Dobutamine Stress Echocardiography</atitle><jtitle>Journal of the American Society of Echocardiography</jtitle><addtitle>J Am Soc Echocardiogr</addtitle><date>2007-03-01</date><risdate>2007</risdate><volume>20</volume><issue>3</issue><spage>257</spage><epage>261</epage><pages>257-261</pages><issn>0894-7317</issn><eissn>1097-6795</eissn><abstract>Background Akinesis becoming dyskinesis (AKBD) at high-dose dobutamine stress echocardiography (DSE) has been disregarded as a marker of myocardial ischemia. However, its prognostic significance is unknown. Objectives We sought to assess the long-term outcome of patients with AKBD during DSE. Methods A total of 731 patients (age 62 ± 15 years, 628 men) with two or more akinetic left ventricular segments at rest underwent DSE and were followed up for a mean period of 5 ± 2.7 years. The end points considered during follow-up were hard cardiac events (cardiac death and nonfatal myocardial infarction) and heart failure. Results Dyskinesis in two or more segments at peak stress developed in 60 patients (8%). Resting wall-motion score index was 2.6 ± 0.56 in patients with AKBD versus 2.3 ± 0.55 in patients without AKBD ( P = .0002). Ischemia occurred in 197 patients (27%). During follow-up, 254 patients (35%) developed hard cardiac events and 204 patients (28%) developed heart failure. In all, 226 patients (31%) died of various causes (cardiac death in 172 patients). The annualized hard cardiac event rate was 11% in patients with AKBD and 6% in patients without ( P = .03). The incidence of heart failure was significantly higher in patients with AKBD than without (47% vs 26%, P < .001). Independent predictors of hard cardiac events were age (hazard ratio [HR] 1.03 [confidence interval {CI} = 1.01-1.04]), previous myocardial infarction (HR 1.4 [CI = 1.1-1.9]), diabetes mellitus (HR 1.8 [CI = 1.3-2.5]), resting wall-motion score index (HR 1.11 [CI = 1.01-1.04]), and AKBD (HR 1.6 [CI = 1.1-2.4]). Conclusion AKBD at peak DSE is associated with increased risk of cardiac events in patients with akinetic segments at baseline echocardiogram.</abstract><cop>United States</cop><pub>Mosby, Inc</pub><pmid>17336751</pmid><doi>10.1016/j.echo.2006.08.043</doi><tpages>5</tpages></addata></record> |
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| subjects | Cardiovascular Cohort Studies Comorbidity Coronary Artery Disease - diagnostic imaging Coronary Artery Disease - mortality Dobutamine Echocardiography, Stress - statistics & numerical data Humans Incidence Italy - epidemiology Male Middle Aged Myocardial Ischemia - diagnostic imaging Myocardial Ischemia - mortality Prevalence Prognosis Reproducibility of Results Risk Assessment - methods Risk Factors Sensitivity and Specificity Survival Analysis Survival Rate Ventricular Dysfunction, Left - diagnostic imaging Ventricular Dysfunction, Left - mortality |
| title | Prognostic Significance of Akinesis Becoming Dyskinesis During Dobutamine Stress Echocardiography |
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