Long term outcome in patients with silent versus symptomatic ischaemia during dobutamine stress echocardiography
| Autor: | Angelo Branzi, M. Bountioukos, Boudewijn J. Krenning, R.T. van Domburg, D Poldermans, Eleni C. Vourvouri, Elena Biagini, A F L Schinkel, Claudio Rapezzi, J.J. Bax, Vittoria Rizzello, J. R. T. C. Roelandt, Chiara Pedone |
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| Přispěvatelé: | Cardiology, Biagini E, Schinkel AF, Bax JJ, Rizzello V, van Domburg RT, Krenning BJ, Bountioukos M, Pedone C, Vourvouri EC, Rapezzi C, Branzi A, Roelandt JR, Poldermans D. |
| Jazyk: | angličtina |
| Rok vydání: | 2005 |
| Předmět: |
OUTCOME
medicine.medical_specialty SILENT ISCHAEMIA Proportional hazards model business.industry Hazard ratio Ischemia Cardiovascular Medicine medicine.disease Asymptomatic Confidence interval Internal medicine Circulatory system medicine Cardiology Myocardial infarction medicine.symptom Cardiology and Cardiovascular Medicine business DOBUTAMINE STRESS ECHOCARDIOGRAPHY Survival analysis |
| Zdroj: | Heart, 91(6), 737-742. BMJ Publishing Group |
| ISSN: | 1355-6037 |
| DOI: | 10.1136/hrt.2004.041087 |
| Popis: | Objectives: To compare the long term prognosis of patients having silent versus symptomatic ischaemia during dobutamine stress echocardiography (DSE). Design: Observational study. Setting: Tertiary referral centre. Patients: 931 patients who experienced stress induced myocardial ischaemia during DSE. Results: Silent ischaemia was present in 643 of 931 patients (69%). The number of dysfunctional segments at rest (mean (SD) 9.6 (5.1) v 8.8 (5.0), p = 0.1) and of ischaemic segments (3.5 (2.2) v 3.8 (2.1), p = 0.2) was comparable in both groups. During a mean (SD) follow up of 5.5 (3.3) years, there were 169 (18%) cardiac deaths and 86 (9%) non-fatal infarctions. Multivariable Cox regression analysis showed age (hazard ratio (HR) 1.1, 95% confidence interval (CI) 1.02 to 1.05), previous myocardial infarction (HR 1.4, 95% CI 1.1 to 2.0), and number of ischaemic segments during the test (HR 2.0, 95% CI 1.0 to 3.7) as independent predictors of cardiac death and myocardial infarction. For every additional ischaemic segment there was a twofold increment in risk of late cardiac events. The annual cardiac death or myocardial infarction rate was 3.0% in patients with symptomatic ischaemia and 4.6% in patients with silent ischaemia (p < 0.01). Silent induced ischaemia was an independent predictor of cardiac death and myocardial infarction (HR 1.7, 95% CI 1.1 to 2.0). During follow up symptomatic patients were treated more often with cardioprotective therapy (p < 0.01) and coronary revascularisation (145 of 288 (50%) v 174 of 643 (27%), p < 0.001). Conclusions: Patients with silent ischaemia had a similar extent of myocardial ischaemia during DSE compared to patients with symptomatic ischaemia but received less cardioprotective treatment and coronary revascularisation and experienced a higher cardiac event rate. |
| Databáze: | OpenAIRE |
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