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Long-Term Prediction of Mortality in Elderly Persons by Dobutamine Stress Echocardiography

¹ Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
² Institute of Cardiology, S. Orsola Hospital, Bologna, Italy.
³ Department of Cardiology, Leiden University Medical Center, The Netherlands.

Address correspondence to Don Poldermans, MD, PhD, Department of Cardiology, Thoraxcenter, Room Ba 300, Erasmus MC, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. E-mail: d.poldermans{at}erasmusmc.nl

Background. Dobutamine stress echocardiography (DSE) was shown to provide incremental prognostic information. However, its role in the prediction of mortality in elderly persons is not well defined. We assessed the value of DSE in the prediction of mortality and hard cardiac events during long-term follow-up in patients older than 65 years.

Methods. We studied 1434 patients >65 years old (mean age 72 ± 3 years) who underwent DSE for evaluation of coronary artery disease. Ischemia was defined as new or worsening wall motion abnormalities. Follow-up events were total mortality and hard cardiac events (cardiac mortality and nonfatal myocardial infarction). Multivariable Cox regression analysis was used to identify the independent predictors of follow-up events.

Results. Ischemia was detected in 675 patients (47%). Five hundred six patients (35%) had a normal study, and 253 (18%) had fixed wall motion abnormalities. During a mean follow-up of 6.5 years, 532 (37%) deaths occurred, of which 249 (17%) were due to cardiac causes. A nonfatal myocardial infarction occurred in 45 patients (3%). Independent predictors of all-cause mortality in a multivariate analysis model were age (hazard ratio [HR] 1.06; 95% confidence interval [CI], 1.05–1.08), male sex (HR 1.5; 95% CI, 1.2–1.8), hypertension (HR 1.2; 95% CI, 1.1–1.4), smoking (HR 1.3; 95% CI, 1.1–1.6), diabetes (HR 1.4; 95% CI, 1.1–1.8), rest wall motion abnormalities (HR 1.07; 95% CI, 1.06–1.09), and ischemia (HR 1.3; 95% CI, 1.1–1.6). Independent predictors of hard cardiac events were age (HR 1.07; 95% CI, 1.05–1.09), male sex (HR 1.3; 95% CI, 1.1–1.7), smoking (HR 1.3; 95% CI, 1.1–1.6), diabetes (HR 1.6; 95% CI, 1.2–2.2), rest wall motion abnormalities (HR 1.13; 95% CI, 1.12–1.16), and ischemia (HR 2.1; 95% CI, 1.5–2.8).

Conclusion. DSE provides independent prognostic information to predict all-cause mortality and hard cardiac events in elderly patients.