Effect of myocardial ischemia during Dobutamine stress echocardiography on cardiac mortality in patients with heart failure secondary to ischemic cardiomyopathy

This study assessed the effect of ischemia during dobutamine stress echocardiography (DSE) on cardiac mortality in patients with heart failure. We studied 528 patients (62 ± 11 years of age, 402 men) who had heart failure and previous myocardial infarction or known coronary artery disease and underwent DSE. Ischemia was defined as new or worsening wall motion abnormalities or a biphasic response. End point during follow-up was cardiac death. Mean ejection fraction was 35 ± 12%. Ischemia was detected in 407 patients (77%). During a mean follow-up of 3.2 ± 2.4 years, cardiac death occurred in 150 patients (28%). Myocardial revascularization was performed within 4 months after DSE in 117 patients (29%) who had ischemia. Annual rates of cardiac death were 4.8% in patients who did not have ischemia, 5.5% in those who had ischemia and underwent revascularization within 4 months, and 11.8% in those who had ischemia and were not revascularized (p