Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 3, Number 2, April 2012, pages 73-79

Quality Assessment in Dobutamine Stress Echocardiography: What are the Clinical Predictors Associated With a Non-Diagnostic Test?

Figure 1. Frequency of dobutamine stress echocardiography test outcomes in patients evaluated for ischemia (n = 467). THR, target heart rate.

Figure 2. Risk stratification by scoring system: percentage of patients with a non-diagnostic test in each score category (n = 467).

**Table 1.** Baseline Characteristics of Patients With Diagnostic and Non-Diagnostic Dobutamine Stress Echocardiography
Clinical Variable	Diagnostic – Positive or Negative Test (n = 383)	Non-Diagnostic (n = 84)	P-value
Age (mean)	59 ± 12	57 ± 10	0.09
Age Group			0.04
< 60 years	193 (50%)	52 (62%)
60 - 69 years	118 (31%)	25 (30%)
≥70 years	72 (19%)	7 (8%)
Mean Body Mass Index (range)	29 (25 - 33)	28 (25 - 35)	0.67
Mean Baseline Heart Rate, bpm (range)	76 (67 - 85)	70 (65 - 77)	< 0.001
Mean Baseline SBP, mmHg (range)	136 (120 - 157)	144 (121 - 167)	0.07
Mean Baseline DBP, mmHg (range)	71 (63 - 81)	74 (62 - 84)	0.60
Hypertension	276 (72%)	69 (82%)	0.057
Previous Myocardial Infarction	33 (9%)	5 (6%)	0.42
Prior Coronary Artery Disease Procedure (Percutaneous Intervention, Coronary Artery Bypass Graft)	49 (13%)	8 (10%)	0.41
Congestive Heart Failure	45 (12%)	11 (13%)	0.73
Diabetes Mellitus	142 (37%)	46 (55%)	0.003
Peripheral Vascular Disease	52 (14%)	12 (14%)	0.86
Hypercholesterolemia	169 (44%)	39 (46%)	0.70
History of Tobacco Use	206 (54%)	50 (60%)	0.35
Beta-Blocker Use	220 (57%)	47 (56%)	0.80
Angiotensin Converting Enzyme Inhibitor	80 (21%)	24 (29%)	0.13
Angiotension Receptor Blocker	58 (15%)	12 (14%)	0.84
Nitrate	19 (5%)	5 (6%)	0.71
Any Calcium Channel Antagonist Use	100 (26%)	31 (37%)	0.046
Dihydropyridine Calcium Channel Antagonist	76 (20%)	22 (26%)	0.196
Non-dihydropyridine
Calcium Channel Antagonist	24 (6%)	9 (11%)	0.150
Statin Use	141 (37%)	32 (38%)	0.83
Amiodarone Use	10 (3%)	3 (4%)	0.63

Table 1. Baseline Characteristics of Patients With Diagnostic and Non-Diagnostic Dobutamine Stress Echocardiography

Clinical Variable

Diagnostic – Positive or Negative Test (n = 383)

Non-Diagnostic (n = 84)

P-value

Age (mean)

59 ± 12

57 ± 10

0.09

Age Group

0.04

< 60 years

193 (50%)

52 (62%)

60 - 69 years

118 (31%)

25 (30%)

≥70 years

72 (19%)

7 (8%)

Mean Body Mass Index (range)

29 (25 - 33)

28 (25 - 35)

0.67

Mean Baseline Heart Rate, bpm (range)

76 (67 - 85)

70 (65 - 77)

< 0.001

Mean Baseline SBP, mmHg (range)

136
(120 - 157)

144
(121 - 167)

0.07

Mean Baseline DBP, mmHg (range)

71 (63 - 81)

74 (62 - 84)

0.60

Hypertension

276 (72%)

69 (82%)

0.057

Previous Myocardial Infarction

33 (9%)

5 (6%)

0.42

Prior Coronary Artery Disease Procedure (Percutaneous Intervention, Coronary Artery Bypass Graft)

49 (13%)

8 (10%)

0.41

Congestive Heart Failure

45 (12%)

11 (13%)

0.73

Diabetes Mellitus

142 (37%)

46 (55%)

0.003

Peripheral Vascular Disease

52 (14%)

12 (14%)

0.86

Hypercholesterolemia

169 (44%)

39 (46%)

0.70

History of Tobacco Use

206 (54%)

50 (60%)

0.35

Beta-Blocker Use

220 (57%)

47 (56%)

0.80

Angiotensin Converting Enzyme Inhibitor

80 (21%)

24 (29%)

0.13

Angiotension Receptor Blocker

58 (15%)

12 (14%)

0.84

Nitrate

19 (5%)

5 (6%)

0.71

Any Calcium Channel Antagonist Use

100 (26%)

31 (37%)

0.046

Dihydropyridine Calcium Channel Antagonist

76 (20%)

22 (26%)

0.196

Non-dihydropyridine

Calcium Channel Antagonist

24 (6%)

9 (11%)

0.150

Statin Use

141 (37%)

32 (38%)

0.83

Amiodarone Use

10 (3%)

3 (4%)

0.63

**Table 2.** Predictors of Non-Diagnostic Testing Identified by Multivariate Logistic Regression Analysis With an Associated Scoring System
Clinical Predictor	Multivariate Odds Ratio (95% CI)	P-value	Scoring System
Age Group	0.47 (0.32 - 0.70)	< 0.001
< 60 years (n = 245)			2
60 - 69 years (n = 143)			1
≥ 70 years (n = 79)			0
Baseline Heart Rate	0.41 (0.28 - 0.62)	< 0.001
< 70 bpm (n = 167)			2
70 - 89 bpm (n = 225)			1
≥ 90 bpm (n = 75)			0
DM	1.91 (1.16 - 3.16)	0.01
Absent (n = 279)			0
Present (n = 188)			1
Hypertension	1.95 (1.02 - 3.71	0.04
Absent (n = 122)			0
Present (n = 345)			1
Scoring System	2.12 (1.65 - 2.73)	< 0.001	0-6

Table 2. Predictors of Non-Diagnostic Testing Identified by Multivariate Logistic Regression Analysis With an Associated Scoring System

Clinical Predictor

Multivariate Odds Ratio (95% CI)

P-value

Scoring System

Age Group

0.47 (0.32 - 0.70)

< 0.001

< 60 years (n = 245)

60 - 69 years (n = 143)

≥ 70 years (n = 79)

Baseline Heart Rate

0.41 (0.28 - 0.62)

< 0.001

< 70 bpm (n = 167)

70 - 89 bpm (n = 225)

≥ 90 bpm (n = 75)

1.91 (1.16 - 3.16)

0.01

Absent (n = 279)

Present (n = 188)

Hypertension

1.95 (1.02 - 3.71

0.04

Absent (n = 122)

Present (n = 345)

Scoring System

2.12 (1.65 - 2.73)

< 0.001

0-6

**Table 3.** Repeat Testing Patterns in Patients With a Non-Diagnostic Vs. Diagnostic DSE (Pearson’s Chi Square Used to Obtain P-Values)
	Non-Diagnostic (n = 84)	Diagnostic (n = 383) Negative (n = 314) Positive (n = 69)	P-value
Nuclear Study	12 (14%)	16 (4%)	P < 0.01
Cardiac Catheterization	12 (14%)	53 (14%)	P = 0.913

Table 3. Repeat Testing Patterns in Patients With a Non-Diagnostic Vs. Diagnostic DSE (Pearson’s Chi Square Used to Obtain P-Values)

Non-Diagnostic (n = 84)

Diagnostic (n = 383)
Negative (n = 314)
Positive (n = 69)

P-value

Nuclear Study

12 (14%)

16 (4%)

P < 0.01

Cardiac Catheterization

12 (14%)

53 (14%)

P = 0.913