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Background: Increasing numbers of octogenarians are being referred for dobutamine stress echocardiography (DSE), in keeping with increased life expectancy. However, the prognostic significance of DSE in this patient population remains unclear. This study aimed to investigate whether DSE predicts total mortality and cardiac events in octogenarians.Methods: Five hundred and fifty consecutive patients >80 years of age (mean age 84 ± 3.7 years) with suspected cardiac chest pain were studied. All had DSE. A positive result was defined as a new or worsening wall motion score in one or more left ventricular segments. Demographic, baseline, and peak DSE data were collected. Total mortality and cardiac events (cardiac mortality and non-fatal myocardial infarction) were prospectively analyzed.Results: DSE was successfully completed in all 550 patients with no adverse outcomes. One hundred and eighty three (33%) patients had a positive DSE result, 271 (49%) had a normal study, and 96 (18%) had fixed wall motion abnormalities. During a mean follow up of 2.14 ± 1.13 years, there were 217 (40%) cardiac events and 63 (12%) deaths, of which 46 (73%) were cardiac. A positive DSE result was associated with significantly increased cardiac events (p < 0.001) but not total mortality. Patients with cardiac events had significantly lower left ventricular (LV) ejection fraction (38 ± 3% vs 48 ± 5%, p < 0.001), higher proportion with a baseline wall motion abnormality (62% vs 28%, p = 0.04), higher proportion with a positive DSE result (68% vs 21%, p = 0.002), higher baseline wall motion score index (WMSI) (1.2 ± 0.5 vs 1.1 ± 0.3, p = 0.002), higher peak WMSI (1.3 ± 0.9 vs 1.1 ± 0.3, p = 0.001), higher systolic blood pressure (144 ± 28 mmHg vs 136 ± 19 mmHg, p = 0.05) and higher diastolic blood pressure (78 ± 25 mmHg vs 67 ± 16 mmHg, p = 0.004). There were no significant differences with regards to age, gender, past history or family history of cardiac disease, smoking, cholesterol, diabetes, NYHA class, medication, previous revascularization, LV wall thickness and left atrial size. With multivariate regression analysis, a positive DSE result (p = 0.001, Exp(B) 1.6, 95% CI 0.79-1.51) and diastolic blood pressure (p = 0.007, Exp(B) 1.98, 95% CI 0.97-0.99) were the only independent predictors of a cardiac event.Conclusion: DSE predicts cardiac events but not total mortality in octogenarians referred with suspected cardiac chest pain. The test is safe and well tolerated in this patient group. A positive DSE result and diastolic blood pressure were the only independent predictors of cardiac events in this population.