| Prediction of mortality and major cardiac events by exercise echocardiography in patients with normal exercise electrocardiographic testing. | |
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MedLine Citation:
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PMID: 19460612 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: We sought to assess the value of exercise echocardiography (EE) for predicting outcome in patients with known or suspected coronary artery disease and normal exercise electrocardiogram (ECG) testing. BACKGROUND: The prognostic value of EE in patients with normal exercise ECG testing has not been characterized. METHODS: We studied 4,004 consecutive patients (2,358 men, mean age [+/- SD] 59.6 +/- 12.5 years) with interpretable ECG who underwent treadmill EE and did not develop chest pain or ischemic ECG abnormalities during the tests. Wall motion score index (WMSI) was evaluated at rest and with exercise, and the difference (DeltaWMSI) was calculated. Ischemia was defined as the development of new or worsening wall motion abnormalities with exercise. End points were all-cause mortality and major cardiac events (MACE). RESULTS: Overall, 669 patients (16.7%) developed ischemia with exercise. During a mean follow-up of 4.5 +/- 3.4 years, 313 patients died, and 183 patients had a MACE before any revascularization procedure. The 5-year mortality and MACE rates were 6.4% and 4.2% in patients without ischemia versus 12.1% and 10.1% in those with ischemia, respectively (p < 0.001). In the multivariate analysis, DeltaWMSI remained an independent predictor of mortality (hazard ratio [HR]: 2.73, 95% confidence interval [CI]: 1.40 to 5.32, p = 0.003) and MACE (HR: 3.59, 95% CI: 1.42 to 9.07, p = 0.007). The addition of the EE results to the clinical, resting echocardiographic and exercise hemodynamic data significantly increased the global chi-square of the models for the prediction of mortality (p = 0.005) and MACE (p = 0.009). CONCLUSIONS: The use of EE provides significant prognostic information for predicting mortality and MACE in patients with interpretable ECG and normal exercise ECG testing. |
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Authors:
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Alberto Bouzas-Mosquera; Jesús Peteiro; Nemesio Alvarez-García; Francisco J Broullón; Victor X Mosquera; Lourdes García-Bueno; Luis Ferro; Alfonso Castro-Beiras |
Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 53 ISSN: 1558-3597 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 2009 May |
Date Detail:
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Created Date: 2009-05-22 Completed Date: 2009-06-09 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 1981-90 Citation Subset: AIM; IM |
Affiliation:
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Department of Cardiology, Hospital Universitario A Coruña, A Coruña, Spain. aboumos@canalejo.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Coronary Artery Disease
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mortality*,
physiopathology,
ultrasonography Death, Sudden, Cardiac / epidemiology, prevention & control* Echocardiography, Stress / methods* Electrocardiography Female Follow-Up Studies Humans Incidence Male Middle Aged Predictive Value of Tests Retrospective Studies Risk Factors Spain / epidemiology Survival Rate / trends |
| Comments/Corrections | |
Comment In:
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J Am Coll Cardiol. 2009 May 26;53(21):1991-2
[PMID:
19460613
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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