Stress echo results predict mortality: a large-scale multicenter prospective international study

J Am Coll Cardiol. 2003 Feb 19;41(4):589-95. doi: 10.1016/s0735-1097(02)02863-2.


Objectives: The purpose of this study was to assess the long-term value of pharmacologic stress echocardiography with either dipyridamole or dobutamine (DET) for prediction of cardiac death in patients with proven or suspected coronary artery disease (CAD).

Background: Stress echocardiography is an established, cost-effective technique for the detection of CAD.

Methods: From the Echo Persantine International Cooperative-Echo Dobutamine International Cooperative data bank, 7,333 patients (5,452 males; 59 +/- 10 years) underwent pharmacologic stress echocardiography with either high-dose dipyridamole (0.84 mg/kg over 10 min) (n = 4,984) or high-dose dobutamine (up to 40 microg/kg/3 min) (n = 2,349) for diagnostic purposes. Patients were followed up for a mean of 2.6 years (range 1 to 206 months).

Results: The DET was positive for myocardial ischemia in 2,854 (35%) patients and negative in 4,479 (61%) patients. During the follow-up there were 161 cardiac deaths (sudden death and fatal myocardial infarction) (2.1% of the total population). Kaplan-Meier survival estimates showed a significantly better outcome for those patients with a negative pharmacologic stress echocardiography test compared with those with a positive test (92 vs. 71.2%, p = 0.0000).

Conclusions: Pharmacologic stress echocardiography with either dipyridamole or dobutamine is effective in predicting cardiac death during a long-term follow-up. A negative stress echocardiography test result is related to a favorable outcome.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Aged
  • Cardiotonic Agents
  • Coronary Artery Disease / diagnostic imaging*
  • Coronary Artery Disease / mortality*
  • Dipyridamole
  • Dobutamine
  • Echocardiography, Stress*
  • Female
  • Follow-Up Studies
  • Humans
  • International Cooperation*
  • Male
  • Middle Aged
  • Platelet Aggregation Inhibitors
  • Predictive Value of Tests
  • Prospective Studies
  • Reproducibility of Results
  • Time Factors


  • Cardiotonic Agents
  • Platelet Aggregation Inhibitors
  • Dobutamine
  • Dipyridamole