Document Detail


Contribution of stress echocardiography to clinical decision making in unselected ambulatory patients with known or suspected coronary artery disease.
MedLine Citation:
PMID:  12127370     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Due to its higher diagnostic accuracy stress echocardiography (SE) has been advocated as a substitute for stress ECG to detect coronary heart disease (CAD). However, its contribution to clinical decision-making in unselected patients presenting to the ambulatory care centre for known or suspected coronary artery disease is unclear. METHODS: To evaluate the clinical value of SE in unselected patients, we prospectively obtained SE and stress ECG in 221 consecutive patients (142 males; mean age 58+/-12 years) presenting to the ambulatory care centre with known or suspected CAD. Patients with acute coronary syndrome were not included. RESULTS: Results of stress ECG and SE were concordant in 181 (82%) and discordant in 40 patients (18%). The clinical decision to recommend or to currently withhold coronary angiography was possible solely on the basis of clinical criteria and stress ECG findings in 191 (86.4%) patients but was guided by the results of SE in 30 patients (13.6%). Left heart catheterization and coronary angiography were conducted in 61 patients. In this population SE was more accurate (82.6%) than stress ECG (65.6%) in indicating significant coronary artery stenosis. CONCLUSION: Despite its higher accuracy, SE adds little to the information derived from dynamic stress ECG and symptom evaluation in unselected outpatients with known or suspected CAD. Thus, SE should not in general replace stress ECG as a screening method for detecting significant coronary artery disease, for both clinical and economic reasons.
Authors:
Ekkehard Grünig; Derliz Mereles; Andreas Benz; Alexander Hansen; Wolfgang Kübler; Helmut Kuecherer
Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article    
Journal Detail:
Title:  International journal of cardiology     Volume:  84     ISSN:  0167-5273     ISO Abbreviation:  Int. J. Cardiol.     Publication Date:  2002 Aug 
Date Detail:
Created Date:  2002-07-19     Completed Date:  2002-10-04     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  179-85     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Internal Medicine III, University Hospital, Bergheimer Strasse 58, D-69115 Heidelberg, Germany. ekkehard_gruenig@med.uni-heidelberg.de
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Blood Pressure / physiology
Coronary Angiography
Coronary Artery Disease / diagnosis*,  physiopathology
Decision Making*
Echocardiography, Stress*
Electrocardiography, Ambulatory
Exercise Test
False Positive Reactions
Female
Heart Conduction System / physiopathology
Heart Rate / physiology
Humans
Male
Middle Aged
Prospective Studies
Sensitivity and Specificity

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


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