Document Detail


Clinical and echocardiographic correlates of health status in patients with acute chest pain.
MedLine Citation:
PMID:  9436894     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To assess the ability of echocardiographic data to predict important functional status outcomes in patients with chest pain.
DESIGN: Prospective cohort study.
SETTING: A large, urban teaching hospital.
PATIENTS: Three hundred thirty-three patients admitted from the Emergency Department for evaluation of chest pain.
MEASUREMENTS AND MAIN RESULTS: Patients underwent two-dimensional and Doppler echocardiography as well as a face-to-face interview during their initial hospitalization and a telephone interview 1 year thereafter. The interview included the Medical Outcomes Study 36-Item Short Form (SF-36) health inventory, a generic health status instrument with a physical function subscale. The relation between clinical and echocardiographic factors and functional status was explored by univariable and multivariable linear regression and logistic regression analyses. Multiple clinical and echocardiographic factors correlated significantly with functional status measures at 1 year. For the SF-36 score at 1 year, age, male gender, white race, the presence of rales, and a comorbidity score were independently predictors in multivariate analysis; echocardiographic findings of severe left ventricular dysfunction (parameter estimate [PE] -27.6; 95% confidence interval [CI] -43.1, -12.2) and aortic insufficiency (PE -16.7; 95% CI -26.4, -7.0) added independent predictive information. Explanatory power (r2) for models using clinical and demographic variables was .27 and increased after inclusion of echocardiographic data to an r2 of .35. Results in the subset of patients (n = 148) with acute coronary syndromes such as unstable angina or myocardial infarction were qualitatively similar. Selected factors (rales on examination, electrocardiographic changes suggestive of ischemia, and moderate to severe mitral regurgitation) also predicted which patients would die or have a decline in their functional status. In multivariate analysis, only rales remained an independent predictor of poor outcome (odds ratio 2.4; 95% CI 1.2, 4.5).
CONCLUSIONS: Echocardiographic data are correlated with measures of functional status in patients with chest pain, but the ability to predict future functional status from clinical or echocardiographic information is limited. Because functional status cannot be predicted adequately from either patients' characteristics or echocardiographic testing, it must be assessed directly.
Authors:
K E Fleischmann; R T Lee; P C Come; L Goldman; K M Kuntz; P A Johnson; M A Weissman; T H Lee
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Journal of general internal medicine     Volume:  12     ISSN:  0884-8734     ISO Abbreviation:  J Gen Intern Med     Publication Date:  1997 Dec 
Date Detail:
Created Date:  1998-02-17     Completed Date:  1998-02-17     Revised Date:  2013-06-11    
Medline Journal Info:
Nlm Unique ID:  8605834     Medline TA:  J Gen Intern Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  751-6     Citation Subset:  IM    
Affiliation:
Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Mass., USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Coronary Disease / diagnosis*,  ultrasonography
Echocardiography, Doppler
Female
Health Status*
Humans
Male
Middle Aged
Predictive Value of Tests
Prognosis
Prospective Studies
Treatment Outcome
Grant Support
ID/Acronym/Agency:
1K08HL02964-01/HL/NHLBI NIH HHS
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