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(Chest. 2001;119:144-149.)
© 2001 American College of Chest Physicians

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

Don Poldermans, MD; Jeroen J. Bax, MD; Abdou Elhendy, MD; Fabiola Sozzi, MD; Eric Boersma, PhD; Ian R. Thomson, MD and Luc J. Jordaens, MD

* From Erasmus Medical Centre, Rotterdam, the Netherlands.

Correspondence to: Don Poldermans, MD, PhD, Thoraxcentre, Room Ba 300, Erasmus University, Dr Molewaterplein 50, 3015 GD Rotterdam, the Netherlands; e-mail: poldermans{at}hlkd.azr.nl

Study objective: To assess the long-term prognostic value of dobutamine stress echocardiography (DSE) for cardiac events (cardiac death, myocardial infarction, and late revascularization) in patients with atrial fibrillation (AF).

Methods: Baseline ECGs were studied in patients undergoing DSE between 1989 and 1998. Sixty-nine patients had AF before DSE. Prognostic value of DSE in these patients was compared with a control group who had sinus rhythm (n = 1,664). The presence of stress-induced ischemia was noted for every patient. The mean follow-up period was 35 months (range, 6 to 84 months). Data are presented as hazards ratio (HR) with 95% confidence interval (CI).

Results: Heart rate at rest was higher in patients with AF (77 ± 15 beats/min vs 73 ± 14 beats/min; p = 0.04); however, double product at peak stress was not different between patients with AF and sinus rhythm (17,602 vs 17,169, respectively; p = 0.46). In patients with AF, target heart rate was achieved at a lower dobutamine dose (33 ± 8 µg/kg/min vs 35 ± 9 µg/kg/min; p = 0.01). Cardiac arrhythmias occurred more frequently (12% vs 5%; p = 0.001) in patients with AF during DSE. During a follow-up period of 7 years, cardiac death occurred in 5 patients, myocardial infarction in 2 patients, and late revascularization in 10 patients. Prognostic value of DSE for all late cardiac events was similar in patients with AF (HR, 3.0; 95% CI, 0.9 to 9.5) and sinus rhythm (HR, 3.4; 95% CI, 2.7 to 4.3; p = 0.85).

Conclusion: The prognostic value of DSE for late cardiac events is maintained in patients with AF.

Key Words: atrial fibrillation • dobutamine stress echocardiography • long-term prognostic value






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