| Dobutamine stress echocardiography for noninvasive assessment and risk stratification of patients with rheumatic mitral stenosis. | |
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MedLine Citation:
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PMID: 15013120 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Gilmar Reis; Mauro S Motta; Marcia M Barbosa; William A Esteves; Sonia F Souza; Edimar A Bocchi |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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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:
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Created Date: 2004-03-11 Completed Date: 2004-04-15 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 393-401 Citation Subset: AIM; IM |
Affiliation:
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Cardiovascular Research Program, Pontificia Universidade Catolica de Minas Gerais, R. Grao Para 454, Santa Efigenia, 30150-340 Belo Horizonte-MG, Brazil. greis@pucminas.br |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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:
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0/Cardiotonic Agents; 34368-04-2/Dobutamine |
| Comments/Corrections | |
Comment In:
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J Am Coll Cardiol. 2004 Feb 4;43(3):402-4
[PMID:
15013121
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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