Prognostic significance of dobutamine stress echocardiography in patients with chronic kidney disease and known or suspected coronary artery disease: a 5-year follow-up study.

Abstract

Dobutamine stress echocardiography (DSE) is an effective noninvasive modality for evaluating coronary artery disease (CAD), with high accuracy. However, data on the prognostic value of DSE in patients with chronic kidney disease (CKD) are limited. This study aims to assess the prognostic significance of DSE in patients with CKD and known or suspected CAD. We included consecutive patients with CKD stage 3 or higher and known or suspected CAD who underwent clinically indicated DSE between 2007 and 2017. The primary endpoint was all-cause mortality at 5 years. Univariable and multivariable analyses were conducted to identify predictors of all-cause mortality, with a p value < 0.05 considered statistically significant. A total of 274 patients were included in the study. The mean age was 64.0 ± 13.1 years, with 54% being male and 13.1% having known CAD. Among the patients, 64.6% had advanced CKD (≥ stage 4). Abnormal DSE was observed in 62 patients (22.6%). During a follow-up period of 7.0 ± 3.5 years, 78 patients (28.5%) died. The mortality rate was significantly higher in patients with abnormal DSE compared to those with normal DSE (48.4% vs. 22.6%, p < 0.001). Multivariable analysis identified age (hazard ratio [HR] 1.03, 95% confidence interval [CI] 1.008-1.05, p = 0.005), New York Heart Association (NYHA) functional class (HR 1.60, 95% CI 1.05-2.43, p = 0.03), and chronotropic index < 0.73 (HR 2.61, 95% CI 1.60-4.25, p < 0.001) as independent predictors of mortality. Conversely, a normal DSE result was found to be a protective factor (HR 0.49, 95% CI 0.30-0.81, p = 0.005). In conclusion, DSE demonstrated significant prognostic value in patients with CKD and known or suspected CAD. Age, NYHA functional class, and a chronotropic index < 0.73 were identified as independent predictors of all-cause mortality.