Long-term Prognostic Value of Dobutamine Stress Echocardiography in Patients With Atrial Fibrillation

To assess the long-term prognosticvalue of dobutamine stress echocardiography (DSE) for cardiac events(cardiac death, myocardial infarction, and late revascularization) inpatients with atrial fibrillation (AF). Baseline ECGs were studied in patients undergoing DSE between 1989 and1998. Sixty-nine patients had AF before DSE. Prognostic value of DSE inthese patients was compared with a control group who had sinus rhythm(n = 1,664). The presence of stress-induced ischemia was noted forevery patient. The mean follow-up period was 35 months (range, 6 to 84months). Data are presented as hazards ratio (HR) with 95% confidenceinterval (CI). Heart rate at rest was higherin patients with AF (77 ± 15 beats/min vs 73 ± 14 beats/min; p = 0.04); however, double product at peak stress was not differentbetween patients with AF and sinus rhythm (17,602 vs 17,169,respectively; p = 0.46). In patients with AF, target heart rate wasachieved at a lower dobutamine dose (33 ± 8 μg/kg/min vs 35 ± 9μg/kg/min; p = 0.01). Cardiac arrhythmias occurred more frequently(12% vs 5%; p = 0.001) in patients with AF during DSE. During afollow-up period of 7 years, cardiac death occurred in 5 patients, myocardial infarction in 2 patients, and late revascularization in 10patients. Prognostic value of DSE for all late cardiac events wassimilar in patients with AF (HR, 3.0; 95% CI, 0.9 to 9.5) and sinusrhythm (HR, 3.4; 95% CI, 2.7 to 4.3; p = 0.85). The prognostic value of DSE for latecardiac events is maintained in patients with, AF.