Journal of the American SocieL 3, of Echocardiography Volume 9 Number 3 Abstracts 397

601J Wall Motion Score Index Predicts Death Better Than Ejection Fraction in Ischemic Cardiemyopathy William V. Novak, M.D.; Stephen G. Sawada, M.D.; Stephen J. Lewis, M.D.; Samer Khonri, M.D.; Judy Foltz, R.N.; Patricia Brenneman; John R. Bates, M.D.; Douglas S. Segar, M.D.; Harve'~, Feigenbaum, M.D.; Indiana University, Indianapolis, IN

Ejection fraction (EF) is an important prognostic indicator in ischemic cardiomyapathy (CADCM). Less is known about the value of wall motion score indices (WMSI) and assessment of contractile reserve for predicting outcome in CADCM. EF and WMSI were measured at rest and with low-dose dobutamine infusion (10 mcg/kg/min) in 36 patients (pts) with CADCM. EF was measured from the 4-chamber view using Simpson's method and WMSI was calculated using a 16 segment model. In 28 months of follow-up, 8 of the 36 (22%) pts hed cardiac deaths. The mean EF at rest in those who died was 36+5% compared to 32±9% in the survivors (p=0.24). The mean low-dose EF was 39+13% in those who died compared to 39_.+9% in the survivors (p=0.97). In comparison, the resting WMSI averaged 2.40±0.34 in those who died versus 2.02_+0.38 in the survivors (p=0.016). The mean low- dose WMSI was 2.24_+0.32 in those who died versus 1.88_+0.40 in survivors (p=0.029). A low-dose WMSI _> 1.9 had 100% sensitivity (8 of 8 pts) and 36% positive predictive value (8 of 22 pts) for identifying pts with cardiac death. A low-dose WMSI < 1.9 had a negative predictive value of 100% (14 of 14 pts). Conclusions: 1) There was no difference in either the testing or low-dose EF in pts with CADCM who died compared to those who survived 2) Patients at high risk for cardiac death were identified by elevated resting and low-dose WMSI and a low-dose WMSI _> 1.9. 3) Patients at low risk for cardiac death were identified by a low- dose WMSI < 1.9.

6 0 1 L DIABETIC PATIENTS HAVE A HIGH INCIDENCE OF NON- DIAGNOSTIC DOBUTAMINE STRESS ECHO RESPONSES. Mafia-Anna Secknus MD, Curtis M Rimmerman MD, Thomas H Marwick MD. Cleveland Clinic Foundation, Cleveland, OH.

Many pts with diabetes (DM) undergo risk stratification for coronary artery disease (CAD). As these pts often cannot exercise maximally, dobutamine stress echo (DbE) may be useful for diagnosis of CAD, but its efficacy in this group has not been studied. Over 12 months, we studied 912 consecutive pts who underwent DbE for diagnostic purposes or risk stratification. Treated DM was present in 145 pts (16%), with comparable numbers with NIDDM and IDDM; the remaining 767 pts served as a control group (C). Db was infused in 3 rain increments from 5 to 40 mcg/kg/min, with atropine (ling) added if required. Hemodynamic, ECG and echo responses were studied. Results: Pts with DM were younger than C (63±13 vs 67±11, p<.005), heavier (88±22 vs 81M8 kg, p<.002) and less often presented with chest pain (18% vs 24%). Positive DbE was more common in DM (24% vs 13%, p<.002). Use of anti-anginal therapy was comparable. Apart from a higher basal heartrate in DM than C (78~:14 vs.74±14, p<.001), resting hemodynamics were similar. During DbE, DM had a greater SBP increment at peak infusion (7±35 vs 0.4±34 mmHg, p<.04), with a threefold higher incidence of SBP>220 mmHg (7.6 vs 2.5%, p<.04). Successful completion of protocol (HR >85% MPI-IR without major side effects) was attained in only 68% DM compared with 82% of controls (p<0.001). Limiting side effects were more common with DM; SBP >_220mmHg (4.1 vs 0.7%, p<0.004), fall in SBP >_20mmHg below baseline (6.2% vs. 2.7%, p<0.05). Groups did not differ with respect to severe chest pain, amhythmias, or requirement ofmed~cai intervention during or immediately after the test. Conclusion: DM is common in pts referred for DbE. While DbE is useful for diagnosis of CAD in these pts, they have a higher frequency of limiting side-effects, and more eonmaonly have a submaximai stress response than non-diabetic patients.

601K Left Ventricular Thrombus: Presence and Safety During Dobutamine Stress Echocardiography David A. Cusick, Gorav Ailawadi, Robert O.Bonow, Farooq A.Chaudhry, Northwestern University, Chicago, Illinois

The safety of dobutamine stress echocardiegraphy (DSE) in pts with LV dysfunction and LV thrembus has not been previously reported. We analyzed clinical and echo variables of 102 pts (mean age 63; range 28-85, 81 males; 21 female) referred for the assessment of myocardial viability and/or ischemia. Pts were divided into 2 groups based on echo visualization of LV thrombus; Group I-definite in 29 pts (28%) and probable in 26 pts (25%) versus Group 2-absent in 47 pts

(46%). A 16 segment model graded 1 to 5 in increasing degree of abnormalities was used for composite and apical wall motion score.

Group (n=5~l Group ~ [n=47~h Ischemic Etiology (% of pts) 87 ~ 58 LV Dimension >60mm (% of pts) 73* 47 LV E3ection Fraction (%) 26 Z 7 28 ± 6 Dobutamine Dose (mcg/kg/min) 18~10" 24±14 Wall Motion Score

Composite 54 ± 6* 47 ± 6 Apical Segments 16 ±3* 12±3

Anticoagulant Therapy (% of pts) 38 23 Double Product 15,708" 18,688

*p<0.05 versus Group 2 There were no thromboembolic complications within 24 hours of DSE. LV ejection fraction was similar between the two groups. However, pts with LV thrombus more frequently had ischemic cardiomyopathy, increased LV dimension, and worse composite and apical wall motion scores. Furthermore, DSE appear to be safe in pts with LV thrombus and LV dysfunction.

601M Dobutamine Echocardiography Has Lower False Positive Rate In Women Than Persantine Thallium

Venkata EmanL Stephen Devries The University of Illinois; Chicago, Illinois

In order to determine if the false positive rate is different in women tested with dobutamine echo compared to persantine thallium, 137 women without a history of coronary disease who underwent either dobutamine echo (n=62) or persantine thallium (n=75) and subsequently went on to coronary angingraphy were studied. Coronary disease was defined as 2t lesion with z50% narrowing. Results: Persantine thallium testing was associated with a significantly higher rate of false positive studies-49% (37/75) than was dobutamine echo-24% (15/62), p<0.005. The average age of women undergoing dobutamine echo and persantine thallium was similar (59 vs 58 years). There was no significant difference in women undergoing thallium versus echo testing in the prevalence of hypertension, hyperlipidemia, smoking or family history of coronary disease; fewer women were diabetic in the thallium group (37%) compared to the echo group (58%), p<0.05. Conclusion: A false positive stress study was more likely to occur in women undergoing persantine thallium than with dobutamine echocardiography. Accordingly, greater utilization of dobutamine echocardiography has the potential to reduce the rate of erroneously diagnosed coronary disease in women and, thereby, lower costs and morbidity by minimizing unnecessary invasive follow-up testing.