TESTING VS. DOBUTAMINE STRESS ECHOCARDIOGRAPHY IN ASSESSMENT
OF ONE-YEAR PROGNOSIS IN PATIENTS WITH IDIOPATHIC DILATED
P. OtaÜeviŠ, Z. PopoviŠ, A. VlahoviŠ, D. BojiŠ, L. Pratali
and A.N. NeÜkoviŠ
Cardiovascular Institute, Belgrade, CNR2, Pisa, Yugoslavia,
to assess prognostic implications of dobutamine echocardiogarphy
(DSE) and exercise testing (ET) with idiopathic dilated cardiomyopathy,
we have analyzed 48 consecutive patients. DSE was performed using
5, 10, 20, 30 and 40 mcg/kg/min infusions, in progressive stages
lasting 5 minutes each. Dobutamine induced changes in wall motion
score index (WMSI), ejection fraction (EF), end-systolic pressure/volume
ratio (ESPVR) and cardiac power output (CPO) were used to test
patients. Patients were subjected to exercise test in form of
bicycle ergometry, whiach was performed in 25 W increments, lasting
120 seconds each, until 150 W or until maximal exercise capacity
was reached. Tests were considered negative if change in WMSI│0.22,
EF│5%, ESPVR│0.4, CPO│1 W, and if exercise time was >240 seconds.
All patients were followed 12 months for combined end-point of
cardiac death, hospitalization for congestive heart failure, and
partial left ventriculectomy. Sensitivity (Sn), specificity (Sp),
accuracy (ACC) and positive and negative predictive values (PPV
and NPV, respectively) were calculated for each test.
Results: The study group consisted of 41 males and 7 females,
aged 50 + 10 years, with 13/48 patients being NYHA III/IV class.
Mean EF was 21▒8%. Results are shown in Table;
Conclusion: It appears that both ET and WMSI are good prognostic
markers, since they both have reasonably good Sn and Sp. On the
other hand, clinical use of other DSE derived indices, except
WMSI, may be limited by their low Sp.