Document Detail


Prediction of outcomes in hypertensive patients with suspected coronary disease.
MedLine Citation:
PMID:  12052851     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Stress echocardiography has been shown to improve the diagnosis of coronary artery disease in the presence of hypertension, but its value in prognostic evaluation is unclear. We sought to determine whether stress echocardiography could be used to predict mortality in 2363 patients with hypertension, who were followed for up to 10 years (mean 4.0+/-1.8) for death and revascularization. Stress echocardiograms were normal in 1483 patients (63%), 16% had resting left ventricular (LV) dysfunction alone, and 21% had ischemia. Abnormalities were confined to one territory in 489 patients (21%) and to multiple territories in 365 patients (15%). Cardiac death was less frequent among the patients able to exercise than among those undergoing dobutamine echocardiography (4% versus 7%, P< 0.001). The risk of death in patients with a negative stress echocardiogram was <1% per year. Ischemia identified by stress echocardiography was an independent predictor of mortality in those able to exercise (hazard ratio 2.21, 95% confidence intervals 1.10 to 4.43, P=0.0001) as well as those undergoing dobutamine echo (hazard ratio 2.39, 95% confidence intervals 1.53 to 3.75, P=0.0001); other predictors were age, heart failure, resting LV dysfunction, and the Duke treadmill score. In stepwise models replicating the sequence of clinical evaluation, the results of stress echocardiography added prognostic power to models based on clinical and stress-testing variables. Thus, the results of stress echocardiography are an independent predictor of cardiac death in hypertensive patients with known or suspected coronary artery disease, incremental to clinical risks and exercise results.
Authors:
Thomas H Marwick; Colin Case; Stephen Sawada; Charles Vasey; James D Thomas
Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Hypertension     Volume:  39     ISSN:  1524-4563     ISO Abbreviation:  Hypertension     Publication Date:  2002 Jun 
Date Detail:
Created Date:  2002-06-07     Completed Date:  2002-06-12     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1113-8     Citation Subset:  IM; S    
Affiliation:
University of Queensland, Brisbane, Australia. tmarwick@medicine.pa.uq.edu.au
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MeSH Terms
Descriptor/Qualifier:
Cohort Studies
Coronary Artery Disease / mortality*,  ultrasonography
Dobutamine / diagnostic use
Echocardiography, Stress / methods*
Exercise Test
Female
Follow-Up Studies
Humans
Hypertension / mortality*,  ultrasonography
Hypertrophy, Left Ventricular / mortality,  ultrasonography
Male
Middle Aged
Prognosis
Survival Rate
Chemical
Reg. No./Substance:
34368-04-2/Dobutamine

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


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