Relation of Dyspnea in Patients Unable to Perform Exercise Stress Testing to Outcome and Myocardial Ischemia

Alain M. Bernheim, Maytinee Kittipovanonth, Christopher G. Scott, Robert B. McCully, Teresa S. Tsang, Patricia Pellikka

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Limited information exists regarding the significance of dyspnea in patients who are unable to exercise and the contribution of myocardial ischemia to this symptom. To assess this, we evaluated results of dobutamine stress echocardiography (DSE) and long-term outcome of patients with dyspnea referred for DSE. We studied 6,376 consecutive patients who were unable to perform an exercise test and were referred for DSE. Patients were classified according to presenting symptoms and followed for 5.5 ± 2.8 years. End points were cardiac ischemic events (myocardial infarction or revascularization), hospitalization for heart failure (HF), and death. Dobutamine stress echocardiogram was positive for ischemia in 19% of patients with dyspnea versus 24% (p = 0.002) of those with typical angina and 17% (p = 0.2) of asymptomatic patients. In multivariate analysis, risk of death was increased in dyspneic patients versus asymptomatic patients (hazard ratio [HR] 1.14, p = 0.02) and patients with chest pain (HR 1.20, p <0.001). Hospitalization for HF occurred more often in patients with dyspnea (HR 1.26, p = 0.05 vs asymptomatic; HR 1.24, p = 0.06 vs chest pain), especially in the subset without previous HF (HR 1.45, p = 0.006 vs chest pain). Risk of cardiac ischemic events in patients with dyspnea was similar versus asymptomatic patients (HR 0.92, p = 0.39) and decreased versus patients with chest pain (HR 0.70, p <0.001). In conclusion, in patients referred for DSE, dyspnea was associated with a poor outcome. This increased hazard seems not to be linked to myocardial ischemia, but instead to HF and death.

Original languageEnglish (US)
Pages (from-to)265-269
Number of pages5
JournalAmerican Journal of Cardiology
Volume104
Issue number2
DOIs
StatePublished - Jul 15 2009

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Dyspnea
Myocardial Ischemia
Exercise
Stress Echocardiography
Chest Pain
Heart Failure
Hospitalization
Myocardial Revascularization
Dobutamine
Exercise Test
Multivariate Analysis
Ischemia
Myocardial Infarction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Relation of Dyspnea in Patients Unable to Perform Exercise Stress Testing to Outcome and Myocardial Ischemia. / Bernheim, Alain M.; Kittipovanonth, Maytinee; Scott, Christopher G.; McCully, Robert B.; Tsang, Teresa S.; Pellikka, Patricia.

In: American Journal of Cardiology, Vol. 104, No. 2, 15.07.2009, p. 265-269.

Research output: Contribution to journalArticle

Bernheim, Alain M. ; Kittipovanonth, Maytinee ; Scott, Christopher G. ; McCully, Robert B. ; Tsang, Teresa S. ; Pellikka, Patricia. / Relation of Dyspnea in Patients Unable to Perform Exercise Stress Testing to Outcome and Myocardial Ischemia. In: American Journal of Cardiology. 2009 ; Vol. 104, No. 2. pp. 265-269.
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