Abstract:
BACKGROUND:The outpatient prognostic assessment of coronary artery disease (CAD) by exercise electrocardiography has limitations, including the feasibility of the test and its low positive predictive value in several clinical conditions. In the current study we investigated the safety, feasibility, and prognostic value of pharmacologic stress echocardiography in a large cohort of ambulatory patients. METHODS:The study group was made of 1482 ambulatory patients (969 men, aged 60 +/- 10 years) who underwent stress echocardiography with either dipyridamole (n = 846) or dobutamine (n = 636) for evaluation of suspected or known stable CAD. The pretest likelihood of CAD was intermediate (<70%) in 709 patients and high (> or =70%) in 773 patients. RESULTS:There was no complication during the dipyridamole test, whereas 2 ischemia-dependent, sustained ventricular tachycardias occurred during the dobutamine test. Limiting side effects were observed in 2% of dipyridamole and in 3% of dobutamine stresses. The echocardiogram was positive in 459 patients. During a mean follow-up of 28 +/- 24 months, 58 patients died, 33 had a nonfatal myocardial infarction, and 158 underwent early (< or =3 months) and 64 late (>3 months) revascularization. Multivariate predictors of hard events (death, infarction) were positive echocardiographic results (hazard ratio [HR] 2.9) and resting wall motion score index (WMSI) (HR 2.3). In considering major events (death, infarction, late revascularization) as end points, positive echocardiographic result (HR 4.3), scar (HR 2.2), and resting WMSI (HR 1.7) were independent prognostic predictors. The 5-year survival rates for the ischemic and nonischemic groups were, respectively, 80% and 91% (HR 3.6, 95% confidence interval [CI] 3.8-8.4; P <.0001) considering hard cardiac events and 65% and 88% (HR 2.6, 95% CI 2.1-5.9; P <.0001) considering major events. Multivariate predictors of major events were positive echocardiographic results (HR 8.2) and male sex (HR 2.5) for the intermediate-risk group and positive echocardiographic results (HR 2.9), resting WMSI (HR 1.8), and prior Q-wave myocardial infarction (HR 1.8) for the high-risk group. CONCLUSIONS:Pharmacologic stress echocardiography is safe, highly feasible, and effective in prognostic assessment of ambulatory patients when both a general population and groups selected on the basis of pretest likelihood of CAD are analyzed. It represents a valid complementary tool to exercise electrocardiography for prognostic purposes in outpatients.
journal_name
Am Heart Jjournal_title
American heart journalauthors
Cortigiani L,Picano E,Coletta C,Chiarella F,Mathias W,Gandolfo N,De Alcantara M,Mazzoni V,Gensini GF,Landi P,Echo Persantine International Cooperative (EPIC) Study Group.,Echo Dobutamine International Cooperative (EDIC) Study Groupdoi
10.1067/mhj.2001.113997subject
Has Abstractpub_date
2001-04-01 00:00:00pages
621-9issue
4eissn
0002-8703issn
1097-6744pii
S0002-8703(01)78537-7journal_volume
141pub_type
杂志文章abstract:BACKGROUND:hypertrophic cardiomyopathy (HCM) is a major cause of sudden death in young athletes and one of the most common inherited cardiovascular diseases, affecting 1 in 500 individuals. Often viewed as a disease of the cardiac sarcomere, mutations in genes encoding myofilament proteins are associated with disease p...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2010.08.001
更新日期:2011-01-01 00:00:00
abstract:BACKGROUND:A large proportion of patients with heart failure (HF) have a large and poorly contracting left ventricle. The noninvasive recognition of the ischemic etiology of such patients is difficult, and for this purpose, usually patients undergo coronary angiography. It has been shown that cardiovascular magnetic re...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2005.03.068
更新日期:2006-01-01 00:00:00
abstract::The method for evaluating right ventricular and pulmonary artery systolic pressures by subtracting the systolic pressure gradient across the ventricular septal defect from the cuff systolic blood pressure is documented. To confirm the reliability and accuracy of this method, simultaneous continuous wave Doppler echoca...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(93)90116-q
更新日期:1993-04-01 00:00:00
abstract:BACKGROUND:The acute benefits of platelet glycoprotein IIb/IIIa inhibitors for non-ST-segment elevation acute coronary syndromes (NSTE ACS) remain unclear. METHODS:In this pilot trial, 311 patients with NSTE ACS were randomly assigned in the emergency department to double-blinded therapy with eptifibatide or placebo f...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/S0002-8703(03)00517-9
更新日期:2003-12-01 00:00:00
abstract::We studied 16 patients with chronic aortic insufficiency to compare a method for measuring regurgitant volume with color Doppler flow mapping to stroke count ratio determined by radionuclide ventriculography and to ventricular volumes assessed by two-dimensional echocardiography. A real-time color flow map of the left...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(89)90868-5
更新日期:1989-05-01 00:00:00
abstract:BACKGROUND:Postinterventional cognitive dysfunction (PICD) is a known complication of coronary artery bypass grafting (CABG). However, it is largely unknown whether PICD occurs after coronary catheterization. METHODS:Neuropsychologic data were obtained from 37 patients who received coronary catheterization and 47 pati...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2011.07.021
更新日期:2011-10-01 00:00:00
abstract:BACKGROUND AND OBJECTIVE:Carcinoid syndrome may involve right carcinoid heart disease (CHD), secondary to the release of vasoactive substances. Left CHD is rare, as the inactivation of serotonin by the lung protects the left heart. We attempted to evaluate the prevalence of CHD and patent foramen ovale (PFO) with seria...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2006.02.019
更新日期:2006-05-01 00:00:00
abstract::Besides reperfusion treatment, which is the most powerful approach to the underlying pathophysiological cause of myocardial infarction, adjunctive therapies should be considered to reduce clinical symptoms, and improve left ventricular function and mortality rates. Randomized clinical trials and overviews of adjunctiv...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/s0002-8703(99)70341-8
更新日期:1999-08-01 00:00:00
abstract::Left ventricular topography and diastolic and systolic functions were studied in 41 patients with essential hypertension (group 1) and 33 age-matched normal adults (group 2) by Doppler echocardiography. In group 1 54% had LV concentric hypertrophy, 19% had combined concentric hypertrophy and eccentric remodeling, and ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(94)90560-6
更新日期:1994-04-01 00:00:00
abstract::Fenoldopam mesylate (SK&F 82526-J) is a novel benzazepine derivative. It has selective agonist activity at post-junctional (DA1) vascular dopaminergic receptors, which normally subserve renal artery vasodilation. Previous studies in normal subjects and in patients with hypertension indicate that fenoldopam increases r...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(88)90620-5
更新日期:1988-08-01 00:00:00
abstract:BACKGROUND:There is increasing evidence that transplantation of autologous stem cells improves cardiac function after acute myocardial infarction (AMI). For propagation of peripheral blood stem cells (PBSCs), application of granulocyte-colony stimulating factor (G-CSF) has been shown to be feasible, effective, and safe...
journal_title:American heart journal
pub_type: 临床试验,杂志文章
doi:10.1016/j.ahj.2006.03.012
更新日期:2006-06-01 00:00:00
abstract:OBJECTIVE:To determine the effect of exercise training on cardiac autonomic modulation in normal older adults by using analysis of heart rate variability. SUBJECTS:The exercise group consisted of 7 men and 9 women aged 66 +/- 4 years. The comparison group consisted of 7 men and 9 women also aged 66 +/- 4 years. METHO...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(99)70162-6
更新日期:1999-09-01 00:00:00
abstract:BACKGROUND:In chronic heart failure the cause of exercise limitation is still unclear: ergoreceptors, muscle afferents sensitive to exercise metabolites, are proposed as a neural link between muscular abnormalities and the limited exercise responses in this syndrome. METHODS:In 92 stable patients with heart failure (3...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(99)70361-3
更新日期:1999-06-01 00:00:00
abstract::Radionuclide angiographic evaluation of LV performance at rest and during exercise in patients with AR have shown that an abnormal EF response to exercise may be observed in asymptomatic patients with normal resting LV function. The EF response to exercise has been correlated with a number of clinical and exercise mea...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(86)90019-0
更新日期:1986-06-01 00:00:00
abstract:BACKGROUND:Decreased heart rate variability (HRV) is often assumed to be associated with mortality in all patients after myocardial infarction (MI), independent of clinical factors or time after MI. METHOD:HRV was determined from Holter tapes in the Cardiac Arrhythmia Suppression Trial (CAST). Patients were 71 +/- 120...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(03)00520-9
更新日期:2004-02-01 00:00:00
abstract:BACKGROUND:Despite the common practice of clopidogrel loading for coronary stenting, the time dependence and degree of platelet inhibition after this therapy are not well defined. We sought to establish an optimal clopidogrel dosing regimen for sustained platelet inhibition in stented patients. METHODS AND RESULTS:Pla...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1067/mhj.2003.109
更新日期:2003-02-01 00:00:00
abstract:BACKGROUND:Although monitoring the clinical status of patients with heart failure rests at the core of clinical medicine, the ability of different techniques to reflect clinical change has not been evaluated. This study sought to describe changes in various measures of disease status associated with gradations of clini...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ahj.2004.12.010
更新日期:2005-10-01 00:00:00
abstract::The stent delivery system (SDS) is a sheath-covered Palmaz-Schatz stent mounted on a 3.0, 3.5, or 4.0 mm compliant polyethylene balloon catheter; the balloon resists maximal inflation pressures of 5.7, 6.2, or 6.0 atm, respectively. It is postulated that these pressures are too low to obtain optimal stent deployment. ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(95)90308-9
更新日期:1995-04-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2004.07.001
更新日期:2005-01-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(94)90476-6
更新日期:1994-08-01 00:00:00
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pub_type: 杂志文章
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更新日期:1996-05-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ahj.2010.11.016
更新日期:2011-03-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章,meta分析,评审
doi:10.1016/j.ahj.2010.06.050
更新日期:2010-11-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(85)90088-2
更新日期:1985-09-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(87)90050-0
更新日期:1987-04-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
doi:10.1067/mhj.2003.26
更新日期:2003-01-01 00:00:00
abstract::The systemic and renal hemodyanmic effects of bupicomide were studied in 10 male patients with uncomplicated essential hypertension of moderate severity. Bupicomide significantly reduced systolic, diastolic, and mean arterial pressure and peripheral vascular resistance and this hypotensive effect was associated with a...
journal_title:American heart journal
pub_type: 临床试验,杂志文章
doi:10.1016/s0002-8703(76)80114-7
更新日期:1976-09-01 00:00:00
abstract::The purpose of this study was to evaluate feasibility, safety, and efficacy of implantation of unsheathed Palmaz-Schatz coronary stents via the radial artery. Anticoagulation after coronary stenting has the hazard of vascular complications if large-bore guiding catheters are introduced via the femoral artery. Such com...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(94)90023-x
更新日期:1994-07-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章,meta分析
doi:10.1016/j.ahj.2010.12.006
更新日期:2011-03-01 00:00:00
abstract:BACKGROUND:Previous studies have generated inconsistent results when attempting to define predictors of stroke and death in patients with endocarditis. We sought to examine the relationship between vegetation 2-dimensional size and stroke in those with infective endocarditis (IE) and to identify differences between aor...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1067/mhj.2001.115790
更新日期:2001-07-01 00:00:00