Abstract:
BACKGROUND:While pharmacologic stress single photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) is used for noninvasive evaluation of patients who are unable to perform treadmill exercise, its impact on net reclassification improvement (NRI) of prognosis is unknown. METHODS:We evaluated the prognostic value of pharmacologic stress MPI for prediction of cardiovascular death or non-fatal myocardial infarction (MI) within 1 year at a single-center, university-based laboratory. We examined continuous and categorical NRI of pharmacologic SPECT-MPI for prediction of outcomes beyond clinical factors alone. RESULTS:Six thousand two hundred forty patients (median age 66 years [IQR 56-74], 3466 men) were studied and followed for 5963 person-years. SPECT-MPI variables associated with increased risk of cardiovascular death or non-fatal MI included summed stress score, stress ST-shift, and post-stress resting left ventricular ejection fraction ≤50%. Compared to a clinical model which included age, sex, cardiovascular disease, risk factors, and medications, model χ(2) (210.5 vs. 281.9, P < .001) and c-statistic (0.74 vs. 0.78, P < .001) were significantly increased by addition of SPECT-MPI predictors (summed stress score, stress ST-shift and stress resting left ventricular ejection fraction). SPECT-MPI predictors increased continuous NRI by 49.4% (P < .001), reclassifying 66.5% of patients as lower risk and 32.8% as higher risk of cardiovascular death or non-fatal MI. Addition of MPI predictors to clinical factors using risk categories, defined as <1%, 1% to 3%, and >3% annualized risk of cardiovascular death or non-fatal MI, yielded a 15.0% improvement in NRI (95% CI 7.6%-27.6%, P < .001). CONCLUSIONS:Pharmacologic stress MPI substantially improved net reclassification of cardiovascular death or MI risk beyond that afforded by clinical factors.
journal_name
Am Heart Jjournal_title
American heart journalauthors
Lee DS,Husain M,Wang X,Austin PC,Iwanochko RMdoi
10.1016/j.ahj.2016.01.012subject
Has Abstractpub_date
2016-04-01 00:00:00pages
138-46eissn
0002-8703issn
1097-6744pii
S0002-8703(16)00027-2journal_volume
174pub_type
杂志文章,多中心研究abstract:BACKGROUND:ISAR-REACT was a trial designed to evaluate whether the glycoprotein IIb/IIIa inhibitor abciximab is beneficial in patients undergoing elective percutaneous coronary intervention (PCI) with stent placement after pretreatment with a 600 mg loading dose of clopidogrel. Objective for the angiographic substudy w...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2005.08.002
更新日期:2006-06-01 00:00:00
abstract::The effects of cytochrome C, an electron carrier in the process of oxidative phosphorylation, on infarct size and regional left ventricular function after a coronary artery occlusion were investigated. Thus, in 30 dogs, 1 minute after left anterior descending coronary artery occlusion, 99mTc-labeled albumin microspher...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(87)90019-6
更新日期:1987-01-01 00:00:00
abstract::In order to properly advise cardiac patients in the regulation of their sexual activity, more basic physiologic information is needed concerning the cardiovascular effects of sexual intercourse. This study examined the effects of the male's position during sexual intercourse on heart rate and blood pressure responses....
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(76)80106-8
更新日期:1976-09-01 00:00:00
abstract::Our experience with the use of five new antiarrhythmic drugs for treating life-threatening arrhythmias in children will be briefly reviewed. Prevention of recurrent episodes of atrial flutter with digoxin and local anesthetic antiarrhythmic drugs often is only moderately successful, benefiting 65% of patients. Amiodar...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(87)90027-5
更新日期:1987-01-01 00:00:00
abstract::Quinidine serum levels and pharmacokinetic data were assessed during steady state therapy with oral quinidine sulfate in 19 hospitalized patients who were being treated for ventricular arrhythmias. A new high performance liquid chromatography assay was employed. Four patients were studied both after the first dose of ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(79)90467-8
更新日期:1979-12-01 00:00:00
abstract::In a demographic study, the black Ohio residents were characterized by those born in Ohio and those born in other regions of the United States, and comparisons were made of rates for all deaths (1960-1967) for coronary heart disease (420), endocarditis and myocardial degeneration (421-422), hypertensive cardiovascular...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(75)90329-4
更新日期:1975-09-01 00:00:00
abstract::An angioplasty catheter was developed to allow measurement of absolute coronary blood flow during interventional procedures. This method uses electrical impedance changes induced by a 0.5 ml bolus of 5% dextrose solution and indicator-dilution principles. The indicator is injected through a port located just proximal ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(91)90184-j
更新日期:1991-03-01 00:00:00
abstract::This study examines the electrophysiologic effects of an intravenous bolus of lidocaine in the normal canine ventricle. In 14 open-chest dogs, left ventricular effective refractory period, ventricular repolarization time, and activation time were measured continuously during ventricular pacing (150/min) before, during...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(85)90559-9
更新日期:1985-03-01 00:00:00
abstract:BACKGROUND:Prior studies regarding the effect of racial status on post-myocardial infarction (MI) in subjects with diabetes have yielded conflicting results. We evaluated the effect of diabetes status on racial differences in post-MI mortality and morbidity for a 7-year period, from 1990 through 1997. METHODS:All pati...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2005.02.042
更新日期:2005-11-01 00:00:00
abstract:BACKGROUND:Lipoprotein lipase (LPL) has a prominent role in the metabolism of triglycerides (TGs) and high-density lipoprotein cholesterol (HDL-C) and is a potential interesting target for the development of antiatherogenic treatment. To provide deeper insight into the role of natural variation in this gene, we investi...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2008.10.008
更新日期:2009-02-01 00:00:00
abstract::Inducible ventricular tachycardia frequently persists despite solitary class I antiarrhythmic drug therapy. To determine the effect of metoprolol as adjuvant therapy, 19 patients with clinical ventricular tachycardia with baseline inducible sustained monomorphic ventricular tachycardia and persistently inducible ventr...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(92)90270-6
更新日期:1992-09-01 00:00:00
abstract:BACKGROUND:Patients with unstable angina (UA) and non-ST-elevation myocardial infarction (NSTEMI) remain at risk for death and cardiac ischemic events after being discharged from the hospital. METHODS:We examined whether the Thrombolysis In Myocardial Infarction (TIMI) risk score for UA/NSTEMI, ascertained at presenta...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1067/mhj.2002.122870
更新日期:2002-06-01 00:00:00
abstract:BACKGROUND:Acute heart failure (AHF) remains a major public health burden with a high prevalence and poor prognosis. Relaxin is a naturally occurring peptide hormone that increases cardiac output, arterial compliance, and renal blood flow during pregnancy. The RELAX-AHF-1 study will evaluate the effect of RLX030 (recom...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.ahj.2011.10.009
更新日期:2012-02-01 00:00:00
abstract:BACKGROUND:Percutaneous coronary intervention (PCI) of saphenous vein graft (SVG) is associated with frequent postprocedural enzyme elevation and late cardiac events. New strategies are proposed to minimize distal embolization and to improve the outcome of patients treated with stenting for SVG lesions. The objectives ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/S0002-8703(03)00309-0
更新日期:2003-09-01 00:00:00
abstract::Studies were conducted in 15 patients with coronary artery disease to determine if the type of pacing used to induce an extrasystole had a bearing on subsequent postextrasystolic potentiation (PESP) and if the fact that these were evaluated in jeopardized or nonjeopardized portions of the ventricle altered the ability...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0002-8703(86)90149-3
更新日期:1986-02-01 00:00:00
abstract::Chronic maintenance tocainide therapy was effective in controlling symptomatic, recurrent ventricular tachycardia in 11 of 15 patients. Patients were selected for tocainide therapy on the basis of refractoriness to conventional antiarrhythmic agents and responsiveness to the intravenous administration of lidocaine. Si...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(80)90208-2
更新日期:1980-12-01 00:00:00
abstract:BACKGROUND:Endothelin 1 is a potent endogenous vasoconstrictor neurohormone, and endothelin 1 plasma concentrations predict adverse outcomes in patients with acute heart failure (AHF). Tezosentan, an intravenous endothelin receptor antagonist, improved hemodynamics in patients with AHF; however, its effects on morbidit...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2005.04.035
更新日期:2005-07-01 00:00:00
abstract:BACKGROUND:We aimed to study the comparative safety and effectiveness of various antithrombotic treatment strategies among older adults with non-ST elevation myocardial infarction (NSTEMI) and atrial fibrillation (AF). METHODS:Using the CRUSADE registry linked to longitudinal Medicare claims data, we examined NSTEMI p...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2012.01.017
更新日期:2012-04-01 00:00:00
abstract::We attempted to determine whether exercise-induced silent myocardial ischemia has different clinical implications in patients with and without pathologic Q waves. We studied 152 patients (121 men and 31 women) who had ischemic ST depression (greater than or equal to 0.05 mV) during exercise tests and greater than or e...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(90)90009-m
更新日期:1990-09-01 00:00:00
abstract::The prevalence of heart failure (HF) is high and still on the rise. In 2004, an estimated 5.2 million adults in the United States carried the diagnosis of HF with a mortality rate of >19%. The incidence of HF is higher in individuals 65 years or older. As the US population grows older, the personal and economic costs ...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/j.ahj.2009.04.007
更新日期:2009-06-01 00:00:00
abstract:OBJECTIVES:We aim to review the studies comparing coronary calcification across different ethnic groups. BACKGROUND:There is still uncertainty regarding ethnic differences in the prevalence, progression, and risk of coronary artery disease. Clues to possible racial differences in rates of coronary heart disease (CHD) ...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/j.ahj.2006.08.008
更新日期:2006-11-01 00:00:00
abstract:BACKGROUND:The nested case-control study is an efficient epidemiological design whereby a case-control approach is employed within an established cohort. The large number of recent prospective studies and randomized trials conducted in cardiology provide cohorts within which the nested case-control approach is increasi...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/S0002-8703(03)00512-X
更新日期:2003-10-01 00:00:00
abstract:BACKGROUND:Angiotensin-converting enzyme inhibitors have been shown to attenuate adverse remodeling after acute myocardial infarction (AMI), and the same has been suggested for angiotensin II type 1 receptor antagonists in animal models. Therefore the aim of the study was to compare the effects of losartan and captopri...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/j.ahj.2003.10.031
更新日期:2004-03-01 00:00:00
abstract::Plasma catecholamine levels were determined in 26 cases of uncomplicated myocardial infarction within 24 hours of onset of acute chest pain. Blood samples were collected at time of entry and at 4-hour intervals during the 48 hours following admission. Average values of plasma catecholamines within 1 hour of onset of p...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(79)90278-3
更新日期:1979-11-01 00:00:00
abstract::The purpose of this study was to investigate the effects of various doses of adenosine administered intravenously on myocardial reperfusion injury in a model with poor collateral blood flow. New Zealand White rabbits were subjected to 30 minutes of occlusion of the obtuse marginal branch of the left circumflex artery ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(91)90567-2
更新日期:1991-11-01 00:00:00
abstract:BACKGROUND:The aim of this study was to assess one-year outcomes of invasive and non-invasive strategies in ST-elevation myocardial infarction (STEMI) among multimorbid older people with complex health needs. METHODS:We included patients, registered between 2006 and 2013 in the SWEDEHEART registry, who were 70 years o...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2019.01.008
更新日期:2019-05-01 00:00:00
abstract:BACKGROUND:Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers effectively reduce blood pressure in patients with renovascular disease (RVD); yet, randomized cardiovascular prevention trials of these drugs typically exclude individuals with this condition. PATIENTS AND METHODS:We studied the ass...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2008.05.013
更新日期:2008-09-01 00:00:00
abstract:BACKGROUND:After the Mustard or Senning procedure, adults with transposition of the great arteries may have right ventricular failure and require consideration of new therapies. A 2-stage arterial switch operation (ASO) may be performed as an alternative to heart transplantation. This procedure is relatively successful...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2003.09.015
更新日期:2004-03-01 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:BACKGROUND:Embolic events to the central nervous system are a major cause of morbidity and mortality in patients with infective endocarditis (IE). The appropriate role of valvular surgery in reducing such embolic events is unclear. The purpose of this study was to determine the relationship between the initiation of an...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2007.07.023
更新日期:2007-12-01 00:00:00