Document Detail

Additional prognostic value of physical examination, exercise testing, and arterial ultrasonography for coronary risk assessment in primary prevention.
MedLine Citation:
PMID:  19853707     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The choice of noninvasive tests used in primary prevention of cardiovascular diseases must be based on medical evidence. The aim of this study was to assess the additional prognostic value, over conventional risk factors, of physical examination, exercise testing, and arterial ultrasonography, in predicting a first coronary event. METHODS: A prospective cohort study was conducted between 1996 and 2004 (n = 2,709), with follow-up in 2006 (response rate 96.6%). Participants had no history or symptoms of cardiovascular disease and had a standardized physical examination, a cardiac exercise testing, and carotid and femoral ultrasonography at baseline. Incident cases of definite coronary events were recorded during follow-up. RESULTS: Over the Framingham risk score, femoral bruit, positive exercise test, intima-media thickness >0.63 mm, and a femoral plaque provided significant additional information to the prediction model. The addition of the exercise test to the traditional risk factors, then the intima-media thickness and lastly the presence of femoral plaques, produces incremental increases in the area under the receiver operating characteristic curve (0.73-0.78, P = .02) and about a 50% increase in the positive predictive value (15.8%-31.4%), with no effect on the negative predictive value (96.4%-96.9%). CONCLUSION: Physical examination, exercise testing, and arterial ultrasonography provide incremental information on the risk of coronary event in asymptomatic adults. Exercise testing and femoral ultrasonography also improve the accuracy of the risk stratification.
Maxime Cournot; Dorota Taraszkiewicz; Jean-Pierre Cambou; Michel Galinier; Henri Boccalon; H??l??ne Hanaire-Broutin; Bernard Chamontin; Didier Carri??; Jean Ferri??res
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Publication Detail:
Type:  Journal Article     Date:  2009-09-24
Journal Detail:
Title:  American heart journal     Volume:  158     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-10-26     Completed Date:  2009-12-31     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  845-51     Citation Subset:  AIM; IM    
INSERM U, Toulouse, France.
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MeSH Terms
Carotid Arteries / ultrasonography*
Coronary Artery Disease / diagnosis*
Exercise Test
Femoral Artery / ultrasonography*
Middle Aged
Physical Examination
Primary Prevention
Risk Assessment
Risk Factors
Tunica Intima / ultrasonography
Tunica Media / ultrasonography

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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