Prognostic Significance of Akinesis Becoming Dyskinesis During Dobutamine Stress Echocardiography

Fabiola B. Sozzi, Abdou Elhendy, Vittoria Rizzello, Elena Biagini, Ron T. van Domburg, Eleni C. Vourvouri, Arend F L Schinkel, Gian Battista Danzi, Jeroen J. Bax, Don Poldermans

Research output: Contribution to journalArticle

Abstract

Background: Akinesis becoming dyskinesis (AKBD) at high-dose dobutamine stress echocardiography (DSE) has been disregarded as a marker of myocardial ischemia. However, its prognostic significance is unknown. Objectives: We sought to assess the long-term outcome of patients with AKBD during DSE. Methods: A total of 731 patients (age 62 ± 15 years, 628 men) with two or more akinetic left ventricular segments at rest underwent DSE and were followed up for a mean period of 5 ± 2.7 years. The end points considered during follow-up were hard cardiac events (cardiac death and nonfatal myocardial infarction) and heart failure. Results: Dyskinesis in two or more segments at peak stress developed in 60 patients (8%). Resting wall-motion score index was 2.6 ± 0.56 in patients with AKBD versus 2.3 ± 0.55 in patients without AKBD (P = .0002). Ischemia occurred in 197 patients (27%). During follow-up, 254 patients (35%) developed hard cardiac events and 204 patients (28%) developed heart failure. In all, 226 patients (31%) died of various causes (cardiac death in 172 patients). The annualized hard cardiac event rate was 11% in patients with AKBD and 6% in patients without (P = .03). The incidence of heart failure was significantly higher in patients with AKBD than without (47% vs 26%, P <.001). Independent predictors of hard cardiac events were age (hazard ratio [HR] 1.03 [confidence interval {CI} = 1.01-1.04]), previous myocardial infarction (HR 1.4 [CI = 1.1-1.9]), diabetes mellitus (HR 1.8 [CI = 1.3-2.5]), resting wall-motion score index (HR 1.11 [CI = 1.01-1.04]), and AKBD (HR 1.6 [CI = 1.1-2.4]). Conclusion: AKBD at peak DSE is associated with increased risk of cardiac events in patients with akinetic segments at baseline echocardiogram.

Original languageEnglish
Pages (from-to)257-261
Number of pages5
JournalJournal of the American Society of Echocardiography
Volume20
Issue number3
DOIs
Publication statusPublished - Mar 2007

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Stress Echocardiography
Confidence Intervals
Heart Failure
Myocardial Infarction

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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Prognostic Significance of Akinesis Becoming Dyskinesis During Dobutamine Stress Echocardiography. / Sozzi, Fabiola B.; Elhendy, Abdou; Rizzello, Vittoria; Biagini, Elena; van Domburg, Ron T.; Vourvouri, Eleni C.; Schinkel, Arend F L; Battista Danzi, Gian; Bax, Jeroen J.; Poldermans, Don.

In: Journal of the American Society of Echocardiography, Vol. 20, No. 3, 03.2007, p. 257-261.

Research output: Contribution to journalArticle

Sozzi, FB, Elhendy, A, Rizzello, V, Biagini, E, van Domburg, RT, Vourvouri, EC, Schinkel, AFL, Battista Danzi, G, Bax, JJ & Poldermans, D 2007, 'Prognostic Significance of Akinesis Becoming Dyskinesis During Dobutamine Stress Echocardiography', Journal of the American Society of Echocardiography, vol. 20, no. 3, pp. 257-261. https://doi.org/10.1016/j.echo.2006.08.043
Sozzi, Fabiola B. ; Elhendy, Abdou ; Rizzello, Vittoria ; Biagini, Elena ; van Domburg, Ron T. ; Vourvouri, Eleni C. ; Schinkel, Arend F L ; Battista Danzi, Gian ; Bax, Jeroen J. ; Poldermans, Don. / Prognostic Significance of Akinesis Becoming Dyskinesis During Dobutamine Stress Echocardiography. In: Journal of the American Society of Echocardiography. 2007 ; Vol. 20, No. 3. pp. 257-261.
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abstract = "Background: Akinesis becoming dyskinesis (AKBD) at high-dose dobutamine stress echocardiography (DSE) has been disregarded as a marker of myocardial ischemia. However, its prognostic significance is unknown. Objectives: We sought to assess the long-term outcome of patients with AKBD during DSE. Methods: A total of 731 patients (age 62 ± 15 years, 628 men) with two or more akinetic left ventricular segments at rest underwent DSE and were followed up for a mean period of 5 ± 2.7 years. The end points considered during follow-up were hard cardiac events (cardiac death and nonfatal myocardial infarction) and heart failure. Results: Dyskinesis in two or more segments at peak stress developed in 60 patients (8{\%}). Resting wall-motion score index was 2.6 ± 0.56 in patients with AKBD versus 2.3 ± 0.55 in patients without AKBD (P = .0002). Ischemia occurred in 197 patients (27{\%}). During follow-up, 254 patients (35{\%}) developed hard cardiac events and 204 patients (28{\%}) developed heart failure. In all, 226 patients (31{\%}) died of various causes (cardiac death in 172 patients). The annualized hard cardiac event rate was 11{\%} in patients with AKBD and 6{\%} in patients without (P = .03). The incidence of heart failure was significantly higher in patients with AKBD than without (47{\%} vs 26{\%}, P <.001). Independent predictors of hard cardiac events were age (hazard ratio [HR] 1.03 [confidence interval {CI} = 1.01-1.04]), previous myocardial infarction (HR 1.4 [CI = 1.1-1.9]), diabetes mellitus (HR 1.8 [CI = 1.3-2.5]), resting wall-motion score index (HR 1.11 [CI = 1.01-1.04]), and AKBD (HR 1.6 [CI = 1.1-2.4]). Conclusion: AKBD at peak DSE is associated with increased risk of cardiac events in patients with akinetic segments at baseline echocardiogram.",
author = "Sozzi, {Fabiola B.} and Abdou Elhendy and Vittoria Rizzello and Elena Biagini and {van Domburg}, {Ron T.} and Vourvouri, {Eleni C.} and Schinkel, {Arend F L} and {Battista Danzi}, Gian and Bax, {Jeroen J.} and Don Poldermans",
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T1 - Prognostic Significance of Akinesis Becoming Dyskinesis During Dobutamine Stress Echocardiography

AU - Sozzi, Fabiola B.

AU - Elhendy, Abdou

AU - Rizzello, Vittoria

AU - Biagini, Elena

AU - van Domburg, Ron T.

AU - Vourvouri, Eleni C.

AU - Schinkel, Arend F L

AU - Battista Danzi, Gian

AU - Bax, Jeroen J.

AU - Poldermans, Don

PY - 2007/3

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N2 - Background: Akinesis becoming dyskinesis (AKBD) at high-dose dobutamine stress echocardiography (DSE) has been disregarded as a marker of myocardial ischemia. However, its prognostic significance is unknown. Objectives: We sought to assess the long-term outcome of patients with AKBD during DSE. Methods: A total of 731 patients (age 62 ± 15 years, 628 men) with two or more akinetic left ventricular segments at rest underwent DSE and were followed up for a mean period of 5 ± 2.7 years. The end points considered during follow-up were hard cardiac events (cardiac death and nonfatal myocardial infarction) and heart failure. Results: Dyskinesis in two or more segments at peak stress developed in 60 patients (8%). Resting wall-motion score index was 2.6 ± 0.56 in patients with AKBD versus 2.3 ± 0.55 in patients without AKBD (P = .0002). Ischemia occurred in 197 patients (27%). During follow-up, 254 patients (35%) developed hard cardiac events and 204 patients (28%) developed heart failure. In all, 226 patients (31%) died of various causes (cardiac death in 172 patients). The annualized hard cardiac event rate was 11% in patients with AKBD and 6% in patients without (P = .03). The incidence of heart failure was significantly higher in patients with AKBD than without (47% vs 26%, P <.001). Independent predictors of hard cardiac events were age (hazard ratio [HR] 1.03 [confidence interval {CI} = 1.01-1.04]), previous myocardial infarction (HR 1.4 [CI = 1.1-1.9]), diabetes mellitus (HR 1.8 [CI = 1.3-2.5]), resting wall-motion score index (HR 1.11 [CI = 1.01-1.04]), and AKBD (HR 1.6 [CI = 1.1-2.4]). Conclusion: AKBD at peak DSE is associated with increased risk of cardiac events in patients with akinetic segments at baseline echocardiogram.

AB - Background: Akinesis becoming dyskinesis (AKBD) at high-dose dobutamine stress echocardiography (DSE) has been disregarded as a marker of myocardial ischemia. However, its prognostic significance is unknown. Objectives: We sought to assess the long-term outcome of patients with AKBD during DSE. Methods: A total of 731 patients (age 62 ± 15 years, 628 men) with two or more akinetic left ventricular segments at rest underwent DSE and were followed up for a mean period of 5 ± 2.7 years. The end points considered during follow-up were hard cardiac events (cardiac death and nonfatal myocardial infarction) and heart failure. Results: Dyskinesis in two or more segments at peak stress developed in 60 patients (8%). Resting wall-motion score index was 2.6 ± 0.56 in patients with AKBD versus 2.3 ± 0.55 in patients without AKBD (P = .0002). Ischemia occurred in 197 patients (27%). During follow-up, 254 patients (35%) developed hard cardiac events and 204 patients (28%) developed heart failure. In all, 226 patients (31%) died of various causes (cardiac death in 172 patients). The annualized hard cardiac event rate was 11% in patients with AKBD and 6% in patients without (P = .03). The incidence of heart failure was significantly higher in patients with AKBD than without (47% vs 26%, P <.001). Independent predictors of hard cardiac events were age (hazard ratio [HR] 1.03 [confidence interval {CI} = 1.01-1.04]), previous myocardial infarction (HR 1.4 [CI = 1.1-1.9]), diabetes mellitus (HR 1.8 [CI = 1.3-2.5]), resting wall-motion score index (HR 1.11 [CI = 1.01-1.04]), and AKBD (HR 1.6 [CI = 1.1-2.4]). Conclusion: AKBD at peak DSE is associated with increased risk of cardiac events in patients with akinetic segments at baseline echocardiogram.

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