Predictors and prognostic significance of atrial fibrillation developed during dobutamine stress echocardiography: A propensity score‐matched comparison

• Published in: Echocardiography (Mount Kisco, N.Y.) Vol. 34; no. 3; pp. 429 - 435
• Main Authors: Acharya, Yuba, Agrawal, Sahil, Bhattarai, Junu, Cotarlan, Vlad, Shirani, Jamshid
• Format: Journal Article
• Language: English
• Published: United States 01.03.2017
• Subjects: Adult; Aged; Aged, 80 and over; atrial fibrillation; Atrial Fibrillation - diagnosis; Atrial Fibrillation - epidemiology; Atrial Fibrillation - physiopathology; dobutamine; dobutamine stress echocardiography; Echocardiography, Stress - methods; Follow-Up Studies; Heart Diseases - epidemiology; Humans; Middle Aged; outcome; Predictive Value of Tests; Prognosis; Propensity Score; propensity score matching; Retrospective Studies; Risk Factors; Survival Analysis; atrial fibrillation; propensity score matching; dobutamine; dobutamine stress echocardiography; prognosis; outcome
• ISSN: 0742-2822; 1540-8175
• DOI: 10.1111/echo.13466

Aims Atrial fibrillation (AF) uncommonly occurs during dobutamine stress echocardiography (DSE). We aimed to characterize the predictors and long‐term prognostic significance of AF during DSE. Methods The clinical, echocardiographic, and outcome data of patients in sinus rhythm who developed AF during DSE were reviewed and compared to a propensity score‐matched group of controls. Results Atrial fibrillation developed in 73 (1% of 7026) patients (age 70±10 years, 58% men). Compared to 144 propensity score‐matched controls without AF during DSE, those with AF were more likely to have had history of prior AF (23% vs 8%, P=.002), known coronary artery disease (CAD; 22% vs 10%, P=.037), enlarged left ventricle (LV; 27% vs 9%, P=.002), LV wall‐motion abnormality (33% vs 12%, P<.0001), enlarged aortic root (22% vs 8%, P=.009), or dilated left atrium (52% vs 30%, P=.002). Multivariate logistic regression analysis identified prior history of AF (OR=3.7, 95% CI 1.5–9.0, P=.005), larger LV size (OR=3.1, 95% CI 1.3–7.3, P=.009), and lower LV ejection fraction (OR=−0.95, 95% CI −0.92 to −0.99, P=.02) as independent predictors of AF during DSE. At a mean follow‐up period of 3.4 (0.5‐7.3) years, those with AF during DSE were more likely to develop new coronary events (22% vs 10%, P=.0372), new‐onset heart failure (19% vs 4%, P=.0003), or die from any cause (27% vs 6%, P<.0001). Kaplan‐Meier curves demonstrated significantly lower event‐free survival in patients compared to controls (P by log‐rank test=.001) over the follow‐up period. Conclusion Dobutamine‐induced AF occurs more commonly in those with prior history of AF and remodeled LV and is associated with unfavorable outcomes.