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. 2025 Mar;40(3):210-218.
doi: 10.1007/s00380-024-02464-9. Epub 2024 Sep 23.

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

Ratthanan Leevongsakorn  1   2 , Yodying Kaolawanich  1   2 , Khemajira Karaketklang  3 , Nithima Ratanasit  4   5
Affiliations

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

Ratthanan Leevongsakorn et al. Heart Vessels. 2025 Mar.

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.

Keywords: Chronic kidney disease; Coronary artery disease; Dobutamine stress echocardiography; Prognosis.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare that they have no conflict of interest. Ethical approval and consent to participate: This study was approved by the Siriraj Institutional Review Board (SIRB), Faculty of Medicine, Siriraj Hospital, Mahidol University (COA no. Si 104/2023). All methods involving human data were conducted in accordance with the Declaration of Helsinki. The requirement for consent was waived by the SIRB due to the study’s retrospective nature and the removal of all personal identifying information. Consent for publication: Not applicable.

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