Document Detail


Clinical, exercise electrocardiographic, and pharmacologic stress echocardiographic findings for risk stratification of hypertensive patients with chest pain.
MedLine Citation:
PMID:  12686332     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Exercise electrocardiography (ECG) is of limited usefulness in hypertensive patients, whereas pharmacologic stress echocardiography can provide diagnostic and prognostic information. The aim of this study was to compare the prognostic value of clinical data, exercise ECG, and pharmacologic stress echocardiography in hypertensive patients with chest pain and to identify the best strategy for their risk stratification. Three hundred sixty-seven hypertensive patients (189 men, age 61 +/- 9 years) with chest pain of unknown origin underwent exercise ECG and pharmacologic stress echocardiography (237 with dipyridamole and 130 with dobutamine) and were followed up for 31 +/- 24 months. Positive exercise ECG (ST-segment shift of > or =1 mm at 80 ms after the J point) and stress echocardiography (new wall motion abnormalities) were found in 130 (35%) and 86 (23%) patients, respectively. During follow-up, there were 13 deaths and 16 myocardial infarctions. Additionally, 43 patients underwent coronary revascularization and were censored accordingly. Of 12 clinical, electrocardiographic, and echocardiographic variables analyzed, a positive result of stress echocardiography was the only multivariate predictor of either death (hazard ratio [HR] 4.7, 95% confidence interval [CI] 1.5 to 14.5, p = 0.007) or hard events (death, myocardial infarction) (HR 4.1, 95% CI 1.8 to 9.3, p = 0.0009). Using an interactive stepwise procedure, stress echocardiography provided additional prognostic information to clinical evaluation and exercise ECG. However, the negative predictive value of the 2 tests was similarly (p = NS) high in assessing 4-year event-free survival. In conclusion, a negative exercise electrocardiographic test identifies low-risk hypertensive patients with chest pain and should be the first-line approach for risk stratification. In contrast, positive exercise ECG is unable to distinguish between patients with different levels of risk. In this case, stress echocardiography provides strong and incremental prognostic power over clinical and exercise electrocardiographic data.
Authors:
Lauro Cortigiani; Claudio Coletta; Riccardo Bigi; Elisabetta Amici; Alessandro Desideri; Leonardo Odoguardi
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The American journal of cardiology     Volume:  91     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2003 Apr 
Date Detail:
Created Date:  2003-04-10     Completed Date:  2003-05-07     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  941-5     Citation Subset:  AIM; IM    
Affiliation:
Cardiology Division, Campo di Marte Hospital, 55032 Lucca, Italy. lacortig@tin.it
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MeSH Terms
Descriptor/Qualifier:
Cardiotonic Agents / diagnostic use*
Chest Pain / complications*
Dipyridamole / diagnostic use*
Dobutamine / diagnostic use*
Echocardiography / methods*
Electrocardiography / methods*
Exercise Test*
Female
Humans
Hypertension / complications*
Male
Middle Aged
Myocardial Infarction / mortality*
Prognosis
Vasodilator Agents / diagnostic use*
Chemical
Reg. No./Substance:
0/Cardiotonic Agents; 0/Vasodilator Agents; 34368-04-2/Dobutamine; 58-32-2/Dipyridamole

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


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