Angiographic appearance of “tumour blush” produced by a large right atrial myxoma

Objective: To establish further the role of dobutamine stress echocardiography (DSE) in prognostication of outcome early after acute myocardial infarction (AMI) Methods: Consecutive patients presenting with AMI were screened for inclusion into the study.212 stable consenting patients underwent DSE a mean (SD) of 4.8 (1.5) days after AMI.Patients were then followed up for 803 (297) days.Results: The mean (SD) resting systolic wall thickening index (SWTI) was 1.6 (0.4), 44% patients had evidence of viability at low dose, and 38% had evidence of ischaemia.During the follow up period 27 (13%) patients died and 16 (8%) had a non-fatal AMI.Independent predictors of both mortality and combined mortality and non-fatal AMI were age (hazard ratio (HR) 1.04/year, p = 0.01, and HR 1.03/ year, p = 0.04, respectively) and SWTI at low dose (HR 3.6, p , 0.01, and HR 2.5, p = 0.02, respectively).Low dose DSE provided incremental information over clinical and resting left ventricular function data for predicting death and non-fatal AMI.For patients who were not revascularised SWTI at peak dose dobutamine was the only independent predictor of mortality.Conclusion: DSE is a powerful predictor of outcome in stable survivors of AMI.The presence of myocardial viability has a positive impact on survival.