Document Detail


Dobutamine stress echocardiography for noninvasive assessment and risk stratification of patients with rheumatic mitral stenosis.
MedLine Citation:
PMID:  15013120     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We sought to evaluate the impact of dobutamine stress echocardiography (DSE) in patients with known rheumatic mitral stenosis (MS) in order to assess its safety, feasibility, and prognostic correlation to well-known clinical outcomes. BACKGROUND: Noninvasive prognostic assessment of MS still represents an unresolved task in patients with clinically challenging disease. METHODS: Dobutamine stress echocardiography was performed in 53 patients with MS (8 males; age 37.4 +/- 11.3 years) with no major complications. RESULTS: During follow-up (60.5 +/- 11.0 months), 29 patients presented with clinical events: 16 hospitalizations, seven cases of acute pulmonary edema, and six symptomatic supraventricular arrhythmias. On multivariate analysis, the diastolic mitral valve mean gradient at peak DSE (DSE-MG) was the best predictor of clinical events (p < 0.008), especially in patients with moderate disease (p < 0.001). The best performance of DSE for the detection of clinical events was obtained at a cut-off value of 18 mm Hg DSE-MG (sensitivity 90%, specificity 87%, and accuracy 90%). The addition of DSE to the conventional cardiology work-up would allow a 17% increment for the detection of high-risk patients in the entire population and a 40% increment in patients with presumed moderate disease. CONCLUSIONS: In patients with MS, DSE is a safe and highly feasible stress test. A DSE-MG > or =18 mm Hg identifies a subgroup of high-risk patients in whom a more aggressive approach may be warranted; on the other hand, patients with a DSE-MG <18 mm Hg predicts an uneventful clinical course and may justify a more conservative strategy.
Authors:
Gilmar Reis; Mauro S Motta; Marcia M Barbosa; William A Esteves; Sonia F Souza; Edimar A Bocchi
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  43     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2004 Feb 
Date Detail:
Created Date:  2004-03-11     Completed Date:  2004-04-15     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  393-401     Citation Subset:  AIM; IM    
Affiliation:
Cardiovascular Research Program, Pontificia Universidade Catolica de Minas Gerais, R. Grao Para 454, Santa Efigenia, 30150-340 Belo Horizonte-MG, Brazil. greis@pucminas.br
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Cardiotonic Agents / diagnostic use
Dobutamine / diagnostic use
Echocardiography, Doppler / methods*
Exercise Test / methods*
Feasibility Studies
Female
Humans
Male
Middle Aged
Mitral Valve Stenosis / etiology,  ultrasonography*
Prognosis
Prospective Studies
Rheumatic Heart Disease / complications,  ultrasonography*
Risk Assessment
Treatment Outcome
Chemical
Reg. No./Substance:
0/Cardiotonic Agents; 34368-04-2/Dobutamine
Comments/Corrections
Comment In:
J Am Coll Cardiol. 2004 Feb 4;43(3):402-4   [PMID:  15013121 ]

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