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Dobutamine stress echocardiography for noninvasive assessment and risk stratification of patients with rheumatic mitral stenosis.

Abstract：

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.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Reis G,Motta MS,Barbosa MM,Esteves WA,Souza SF,Bocchi EA

doi

10.1016/j.jacc.2003.09.037

subject

Has Abstract

pub_date

2004-02-04 00:00:00

pages

393-401

issue

3

eissn

0735-1097

issn

1558-3597

pii

S0735109703014876

journal_volume

43

pub_type

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