Document Detail


The incremental prognostic value of pharmacological stress echo over exercise electrocardiography in women with chest pain of unknown origin.
MedLine Citation:
PMID:  11161916     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: The value of exercise electrocardiography in evaluating women with suspected coronary artery disease is limited. Conversely, stress echocardiography is effective for both diagnostic and prognostic purposes in females. The purpose of the study was to determine the relative prognostic value of exercise electrocardiography and pharmacological stress echocardiography in a cohort of women with chest pain of unknown origin, in order to verify whether criteria could be established for the daily non-invasive evaluation of such a low-risk profile population. METHODS AND RESULTS: Exercise electrocardiography and pharmacological stress echocardiography (171 dipyridamole, 73 dobutamine) were performed in 244 women (age 60+/-10 years) with chest pain and known coronary artery disease. A positive result of exercise electrocardiography (ST-segment shift > or =1 mm at 80 ms after the J point) was detected in 95 patients; a positive result of stress echocardiography (new regional wall motion abnormalities) was observed in 33 patients. During follow-up (36+/-18 months), two deaths, five infarctions, seven unstable anginas, and 11 coronary revascularizations occurred. Using Cox analysis, the positive result of stress echocardiography (odds ratio=40.1) alone, was independently related to hard cardiac events (death, infarction). With spontaneous cardiac events (death, infarction, and unstable angina) as end-points, the multivariate prognostic predictors were a positive result of stress echocardiography (odds ratio=37.0), a family history of coronary artery disease (odds ratio=4.1), typical chest pain (odds ratio=3.7), and a positive exercise electrocardiography result with a rate-pressure product < or =20 000 (odds ratio=3.5). By adopting an interactive stepwise procedure, the prognostic value of stress echocardiography was incremental to that of clinical and exercise electrocardiography data. Nevertheless, the negative result of exercise electrocardiography and pharmacological stress predicted a very high and comparable (P=ns) 24-month survival rate when both hard and spontaneous cardiac events were taken as end-points. CONCLUSIONS: In women with chest pain, stress echocardiography is a strong and independent prognostic indicator, incremental to that shown by exercise electrocardiography. However, the two tests have a similar high negative predictive value in this population. Therefore, exercise electrocardiography has to be considered the initial approach and the only test when the result is negative, whereas stress echocardiography is warranted in selected conditions, including those in women with uninterpretable electrocardiograms, those unable to exercise maximally, and those with an ambiguous or ischaemic response to exercise electrocardiography.
Authors:
C Dodi; L Cortigiani; M Masini; I Olivotto; A Azzarelli; E Nannini
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European heart journal     Volume:  22     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2001 Jan 
Date Detail:
Created Date:  2001-02-22     Completed Date:  2001-06-07     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  145-52     Citation Subset:  IM    
Copyright Information:
Copyright 2001 The European Society of Cardiology.
Affiliation:
Cardiovascular Unit, Hospital of Guastalla, Reggio Emilia, Italy.
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MeSH Terms
Descriptor/Qualifier:
Aged
Chest Pain / ultrasonography*
Dipyridamole / diagnostic use
Dobutamine / diagnostic use
Echocardiography / methods
Electrocardiography
Exercise Test
Female
Follow-Up Studies
Humans
Ischemia / diagnosis
Middle Aged
Predictive Value of Tests
Prognosis
Survival Analysis
Chemical
Reg. No./Substance:
34368-04-2/Dobutamine; 58-32-2/Dipyridamole
Comments/Corrections
Comment In:
Eur Heart J. 2001 Jan;22(2):107-9   [PMID:  11161911 ]

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