Document Detail

Vasodilator stress echocardiography for risk stratification of medically stabilized unstable angina.
MedLine Citation:
PMID:  12067536     Owner:  NLM     Status:  MEDLINE    
AIMS: The aims of this study were to assess the safety, feasibility and prognostic value of dipyridamole-atropine stress echo in patients with medically stabilized unstable angina. METHODS: The initial population consisted of 173 patients consecutively admitted at two different Coronary Care Units with class IIIB unstable angina. Of these, 56 were excluded: five had poor acoustic window, 24 did not stabilize with medical therapy and underwent urgent coronary angiography, 26 evolved in non-Q wave myocardial infarction and one patient died. The remaining 117 patients underwent dipyridamole-atropine stress echo after 48 h without symptoms or electrocardiographic evidence of myocardial ischaemia. RESULTS: No complications or side effects occurred. An ischaemic response was found in 61 patients. During follow-up (10+/-9 months), three cardiac deaths, eight infarctions, 13 unstable anginas, and seven late (>3 months from stress testing) revascularizations occurred. There were 22 events (36%) in patients with, and nine events (16%) in patients without, inducible ischaemia (P=0.01). At Cox analysis peak-stress wall-motion score index (HR=5.5; 95% CI, 1.9 to 15.5; P=0.0015), and admission ST-segment depression (HR=4.2; 95% CI, 1.7 to 10.7; P=0.0022) were independent predictors of spontaneous events (cardiac death, infarction, unstable angina). The 12-month event-free survival was 69% for ischaemic and 83% for non-ischaemic group (P=0.03). In considering major events as end-points (spontaneous events, and late revascularization), again multivariate prognostic indicators were peak-stress wall-motion score index (HR=14.2; 95% CI, 2.6 to 76.6; P=0.0021), and admission ST-segment depression (HR=3.1; 95% CI, 1.4 to 6.9; P=0.0055). The 12-month event-free survival rate was 58% for ischaemic and 81% for non-ischaemic group (P=0.002). With an interactive stepwise procedure, stress echo findings were found to provide incremental prognostic contribution to that of clinical data alone. CONCLUSIONS: With proper selection of patients, dipyridamole-atropine stress echo is extremely safe and feasible in patients with medically stabilized unstable angina, and can be useful in identification of subjects at risk for future cardiac events.
G Gigli; L Cortigiani; A Vallebona; S Orlandi; P R Mariani; C Volterrani
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology     Volume:  3     ISSN:  1525-2167     ISO Abbreviation:  Eur J Echocardiogr     Publication Date:  2002 Mar 
Date Detail:
Created Date:  2002-06-17     Completed Date:  2002-08-30     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  100890618     Medline TA:  Eur J Echocardiogr     Country:  England    
Other Details:
Languages:  eng     Pagination:  59-66     Citation Subset:  IM    
Copyright Information:
Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.
Cardiovascular Units, Hospitals of Rapallo (Genova), and Lucca, Italy.
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MeSH Terms
Angina, Unstable / diagnosis,  mortality,  ultrasonography*
Atropine / diagnostic use
Dipyridamole / diagnostic use
Echocardiography, Stress*
Prospective Studies
Risk Assessment
Survival Rate
Vasodilator Agents / diagnostic use*
Reg. No./Substance:
0/Vasodilator Agents; 51-55-8/Atropine; 58-32-2/Dipyridamole

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

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