Prediction of mortality using dobutamine echocardiography
OBJECTIVES We sought to find out whether dobutamine echocardiography (DbE) could provide independent prediction of total and cardiac mortality, incremental to clinical and angiographic variables. BACKGROUND Existing outcome studies with DbE have examined composite end points, rather than death, over...
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creator | Marwick, Thomas H Case, Colin Sawada, Stephen Rimmerman, Curtis Brenneman, Patricia Kovacs, Roxanne Short, Leanne Lauer, Michael |
description | OBJECTIVES
We sought to find out whether dobutamine echocardiography (DbE) could provide independent prediction of total and cardiac mortality, incremental to clinical and angiographic variables.
BACKGROUND
Existing outcome studies with DbE have examined composite end points, rather than death, over a relatively short follow-up.
METHODS
Clinical and stress data were collected in 3,156 patients (age 63 ± 12 years, 1,801 men) undergoing DbE. Significant stenoses (>50% diameter) were identified in 70% of 1,073 patients undergoing coronary angiography. Total and cardiac mortality were identified over nine years of follow-up (mean 3.8 ± 1.9). Cox models were used to analyze the effect of ischemia and other variables, independent of other determinants of mortality.
RESULTS
The dobutamine echocardiogram was abnormal in 1,575 patients (50%). Death occurred in 716 patients (23%), 259 of whom (8%) were thought to have died from cardiac causes. Patients with normal DbE had a total mortality of 8% per year and a cardiac mortality of 1% per year over the first four years of follow-up. Ischemia and the extent of abnormal wall motion were independent predictors of cardiac death, together with age and heart failure. In sequential Cox models, the predictive power of clinical data alone (model chi-square 115) was strengthened by adding the resting left ventricular function (model chi-square 138) and the results of DbE (model chi-square 181). In the subgroup undergoing coronary angiography, the power of the model was increased to a minor degree by the addition of coronary anatomy data.
CONCLUSIONS
Dobutamine echocardiography is an independent predictor of death, incremental to other data. While a normal dobutamine echocardiogram predicts low risk of cardiac death (on the order of 1% per year), this risk increases with the extent of abnormal wall motion at rest and stress. |
doi_str_mv | 10.1016/S0735-1097(00)01191-8 |
format | Article |
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We sought to find out whether dobutamine echocardiography (DbE) could provide independent prediction of total and cardiac mortality, incremental to clinical and angiographic variables.
BACKGROUND
Existing outcome studies with DbE have examined composite end points, rather than death, over a relatively short follow-up.
METHODS
Clinical and stress data were collected in 3,156 patients (age 63 ± 12 years, 1,801 men) undergoing DbE. Significant stenoses (>50% diameter) were identified in 70% of 1,073 patients undergoing coronary angiography. Total and cardiac mortality were identified over nine years of follow-up (mean 3.8 ± 1.9). Cox models were used to analyze the effect of ischemia and other variables, independent of other determinants of mortality.
RESULTS
The dobutamine echocardiogram was abnormal in 1,575 patients (50%). Death occurred in 716 patients (23%), 259 of whom (8%) were thought to have died from cardiac causes. Patients with normal DbE had a total mortality of 8% per year and a cardiac mortality of 1% per year over the first four years of follow-up. Ischemia and the extent of abnormal wall motion were independent predictors of cardiac death, together with age and heart failure. In sequential Cox models, the predictive power of clinical data alone (model chi-square 115) was strengthened by adding the resting left ventricular function (model chi-square 138) and the results of DbE (model chi-square 181). In the subgroup undergoing coronary angiography, the power of the model was increased to a minor degree by the addition of coronary anatomy data.
CONCLUSIONS
Dobutamine echocardiography is an independent predictor of death, incremental to other data. While a normal dobutamine echocardiogram predicts low risk of cardiac death (on the order of 1% per year), this risk increases with the extent of abnormal wall motion at rest and stress.</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/S0735-1097(00)01191-8</identifier><identifier>PMID: 11693748</identifier><identifier>CODEN: JACCDI</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Aged ; Biological and medical sciences ; Cardiovascular system ; Coronary Angiography ; Coronary Disease - diagnostic imaging ; Coronary Disease - mortality ; Coronary Stenosis - diagnostic imaging ; Coronary Stenosis - mortality ; Echocardiography, Stress ; Female ; Humans ; Investigative techniques, diagnostic techniques (general aspects) ; Male ; Medical sciences ; Middle Aged ; Prognosis ; Proportional Hazards Models ; Prospective Studies ; Risk Assessment ; Ultrasonic investigative techniques</subject><ispartof>Journal of the American College of Cardiology, 2001-03, Vol.37 (3), p.754-760</ispartof><rights>2001 American College of Cardiology</rights><rights>2001 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c588t-1cd61ec86a360b1ff0d2516384a6b597e0aea4a6ced09f1c695a4a457eeb4bc53</citedby><cites>FETCH-LOGICAL-c588t-1cd61ec86a360b1ff0d2516384a6b597e0aea4a6ced09f1c695a4a457eeb4bc53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/S0735-1097(00)01191-8$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=916366$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11693748$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Marwick, Thomas H</creatorcontrib><creatorcontrib>Case, Colin</creatorcontrib><creatorcontrib>Sawada, Stephen</creatorcontrib><creatorcontrib>Rimmerman, Curtis</creatorcontrib><creatorcontrib>Brenneman, Patricia</creatorcontrib><creatorcontrib>Kovacs, Roxanne</creatorcontrib><creatorcontrib>Short, Leanne</creatorcontrib><creatorcontrib>Lauer, Michael</creatorcontrib><title>Prediction of mortality using dobutamine echocardiography</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>OBJECTIVES
We sought to find out whether dobutamine echocardiography (DbE) could provide independent prediction of total and cardiac mortality, incremental to clinical and angiographic variables.
BACKGROUND
Existing outcome studies with DbE have examined composite end points, rather than death, over a relatively short follow-up.
METHODS
Clinical and stress data were collected in 3,156 patients (age 63 ± 12 years, 1,801 men) undergoing DbE. Significant stenoses (>50% diameter) were identified in 70% of 1,073 patients undergoing coronary angiography. Total and cardiac mortality were identified over nine years of follow-up (mean 3.8 ± 1.9). Cox models were used to analyze the effect of ischemia and other variables, independent of other determinants of mortality.
RESULTS
The dobutamine echocardiogram was abnormal in 1,575 patients (50%). Death occurred in 716 patients (23%), 259 of whom (8%) were thought to have died from cardiac causes. Patients with normal DbE had a total mortality of 8% per year and a cardiac mortality of 1% per year over the first four years of follow-up. Ischemia and the extent of abnormal wall motion were independent predictors of cardiac death, together with age and heart failure. In sequential Cox models, the predictive power of clinical data alone (model chi-square 115) was strengthened by adding the resting left ventricular function (model chi-square 138) and the results of DbE (model chi-square 181). In the subgroup undergoing coronary angiography, the power of the model was increased to a minor degree by the addition of coronary anatomy data.
CONCLUSIONS
Dobutamine echocardiography is an independent predictor of death, incremental to other data. While a normal dobutamine echocardiogram predicts low risk of cardiac death (on the order of 1% per year), this risk increases with the extent of abnormal wall motion at rest and stress.</description><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Cardiovascular system</subject><subject>Coronary Angiography</subject><subject>Coronary Disease - diagnostic imaging</subject><subject>Coronary Disease - mortality</subject><subject>Coronary Stenosis - diagnostic imaging</subject><subject>Coronary Stenosis - mortality</subject><subject>Echocardiography, Stress</subject><subject>Female</subject><subject>Humans</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Prospective Studies</subject><subject>Risk Assessment</subject><subject>Ultrasonic investigative techniques</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkN9r2zAQgEVpabKuf0KLoTC2B293sSVLT2WU_oLCBmufhSyfExXbSiW7kP--ahPSx8HBneC7093H2BnCTwQUv_5BVfAcQVXfAX4AosJcHrA5ci7zgqvqkM33yIx9ifEZAIREdcxmiEIVVSnnTP0N1Dg7Oj9kvs16H0bTuXGTTdENy6zx9TSa3g2UkV15a0Lj_DKY9WrzlR21pot0ussn7Onm-vHqLn_4c3t_9fsht1zKMUfbCCQrhSkE1Ni20Cw4ikKWRtRpTQJDJtWWGlAtWqF4epa8IqrL2vLihH3bzl0H_zJRHHXvoqWuMwP5KepqsShTYAL5FrTBxxio1evgehM2GkG_O9MfzvS7EA2gP5xpmfrOdx9MdU_NZ9dOUgIudoCJ1nRtMIN1cc-pdI0QibrcUpRkvDoKOlpHQ7rLBbKjbrz7zyJvNXKIsQ</recordid><startdate>20010301</startdate><enddate>20010301</enddate><creator>Marwick, Thomas H</creator><creator>Case, Colin</creator><creator>Sawada, Stephen</creator><creator>Rimmerman, Curtis</creator><creator>Brenneman, Patricia</creator><creator>Kovacs, Roxanne</creator><creator>Short, Leanne</creator><creator>Lauer, Michael</creator><general>Elsevier Inc</general><general>Elsevier Science</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><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>20010301</creationdate><title>Prediction of mortality using dobutamine echocardiography</title><author>Marwick, Thomas H ; Case, Colin ; Sawada, Stephen ; Rimmerman, Curtis ; Brenneman, Patricia ; Kovacs, Roxanne ; Short, Leanne ; Lauer, Michael</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c588t-1cd61ec86a360b1ff0d2516384a6b597e0aea4a6ced09f1c695a4a457eeb4bc53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2001</creationdate><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Cardiovascular system</topic><topic>Coronary Angiography</topic><topic>Coronary Disease - diagnostic imaging</topic><topic>Coronary Disease - mortality</topic><topic>Coronary Stenosis - diagnostic imaging</topic><topic>Coronary Stenosis - mortality</topic><topic>Echocardiography, Stress</topic><topic>Female</topic><topic>Humans</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Prognosis</topic><topic>Proportional Hazards Models</topic><topic>Prospective Studies</topic><topic>Risk Assessment</topic><topic>Ultrasonic investigative techniques</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Marwick, Thomas H</creatorcontrib><creatorcontrib>Case, Colin</creatorcontrib><creatorcontrib>Sawada, Stephen</creatorcontrib><creatorcontrib>Rimmerman, Curtis</creatorcontrib><creatorcontrib>Brenneman, Patricia</creatorcontrib><creatorcontrib>Kovacs, Roxanne</creatorcontrib><creatorcontrib>Short, Leanne</creatorcontrib><creatorcontrib>Lauer, Michael</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><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 College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Marwick, Thomas H</au><au>Case, Colin</au><au>Sawada, Stephen</au><au>Rimmerman, Curtis</au><au>Brenneman, Patricia</au><au>Kovacs, Roxanne</au><au>Short, Leanne</au><au>Lauer, Michael</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prediction of mortality using dobutamine echocardiography</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>2001-03-01</date><risdate>2001</risdate><volume>37</volume><issue>3</issue><spage>754</spage><epage>760</epage><pages>754-760</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><coden>JACCDI</coden><abstract>OBJECTIVES
We sought to find out whether dobutamine echocardiography (DbE) could provide independent prediction of total and cardiac mortality, incremental to clinical and angiographic variables.
BACKGROUND
Existing outcome studies with DbE have examined composite end points, rather than death, over a relatively short follow-up.
METHODS
Clinical and stress data were collected in 3,156 patients (age 63 ± 12 years, 1,801 men) undergoing DbE. Significant stenoses (>50% diameter) were identified in 70% of 1,073 patients undergoing coronary angiography. Total and cardiac mortality were identified over nine years of follow-up (mean 3.8 ± 1.9). Cox models were used to analyze the effect of ischemia and other variables, independent of other determinants of mortality.
RESULTS
The dobutamine echocardiogram was abnormal in 1,575 patients (50%). Death occurred in 716 patients (23%), 259 of whom (8%) were thought to have died from cardiac causes. Patients with normal DbE had a total mortality of 8% per year and a cardiac mortality of 1% per year over the first four years of follow-up. Ischemia and the extent of abnormal wall motion were independent predictors of cardiac death, together with age and heart failure. In sequential Cox models, the predictive power of clinical data alone (model chi-square 115) was strengthened by adding the resting left ventricular function (model chi-square 138) and the results of DbE (model chi-square 181). In the subgroup undergoing coronary angiography, the power of the model was increased to a minor degree by the addition of coronary anatomy data.
CONCLUSIONS
Dobutamine echocardiography is an independent predictor of death, incremental to other data. While a normal dobutamine echocardiogram predicts low risk of cardiac death (on the order of 1% per year), this risk increases with the extent of abnormal wall motion at rest and stress.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>11693748</pmid><doi>10.1016/S0735-1097(00)01191-8</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Aged Biological and medical sciences Cardiovascular system Coronary Angiography Coronary Disease - diagnostic imaging Coronary Disease - mortality Coronary Stenosis - diagnostic imaging Coronary Stenosis - mortality Echocardiography, Stress Female Humans Investigative techniques, diagnostic techniques (general aspects) Male Medical sciences Middle Aged Prognosis Proportional Hazards Models Prospective Studies Risk Assessment Ultrasonic investigative techniques |
title | Prediction of mortality using dobutamine echocardiography |
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