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

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-of 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 greater than or equal to18 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. (C) 2004 by the American College of Cardiology Foundation.