Krivokapich J, Child J S, Walter D O, Garfinkel A
Department of Medicine, UCLA School of Medicine, Los Angeles, California 90095-1679, USA.
J Am Coll Cardiol. 1999 Mar;33(3):708-16. doi: 10.1016/s0735-1097(98)00632-9.
The study sought to determine the utility of dobutamine stress echocardiography (DSE) in predicting cardiac events in the year after testing.
Increasingly, DSE has been applied to risk stratification of patients.
Medical records of 1,183 consecutive patients who underwent DSE were reviewed. The cardiac events that occurred during the 12 months after DSE were tabulated: myocardial infarction (MI), cardiac death, percutaneous transluminal coronary angioplasty (PTCA), and coronary artery bypass surgery (CABG). Patient exclusions included organ transplant receipt or evaluation, recent PTCA, noncardiac death, and lack of follow-up. A positive stress echocardiogram (SE) was defined as new or worsened wall-motion abnormalities (WMAs) consistent with ischemia during DSE. Classification and regression tree (CART) analysis identified variables that best predicted future cardiac events.
The average age was 68+/-12 years, with 338 women and 220 men. The overall cardiac event rate was 34% if SE was positive, and 10% if it was negative. The event rates for MI and death were 10% and 8%, respectively, if SE was positive, and 3% and 3%, respectively, if SE was negative. If an ischemic electrocardiogram (ECG) and a positive SE were present, the overall event rate was 42%, versus a 7% rate when ECG and SE were negative for ischemia. Rest WMA was the most useful variable in predicting future cardiac events using CART: 25% of patients with and 6% without a rest WMA had an event. Other important variables were a dobutamine EF <52.5%, a positive SE, an ischemic ECG response, history of hypertension and age.
A positive SE provides useful prognostic information that is enhanced by also considering rest-wall motion, stress ECG response, and dobutamine EF.
本研究旨在确定多巴酚丁胺负荷超声心动图（DSE）在预测检查后一年内心脏事件方面的效用。
DSE越来越多地应用于患者的危险分层。
回顾了1183例连续接受DSE检查患者的病历。记录DSE后12个月内发生的心脏事件：心肌梗死（MI）、心源性死亡、经皮腔内冠状动脉成形术（PTCA）和冠状动脉搭桥术（CABG）。排除标准包括接受器官移植或评估、近期PTCA、非心源性死亡以及缺乏随访。负荷超声心动图（SE）阳性定义为DSE期间出现新的或加重的与缺血一致的室壁运动异常（WMA）。分类回归树（CART）分析确定了最能预测未来心脏事件的变量。
平均年龄为68±12岁，女性338例，男性220例。SE阳性时总体心脏事件发生率为34%，SE阴性时为10%。SE阳性时MI和死亡的发生率分别为10%和8%，SE阴性时分别为3%和3%。若存在缺血性心电图（ECG）且SE阳性，总体事件发生率为42%，而ECG和SE均无缺血表现时发生率为7%。静息WMA是使用CART预测未来心脏事件最有用的变量：有静息WMA的患者中有25%发生事件，无静息WMA的患者中有6%发生事件。其他重要变量包括多巴酚丁胺激发后射血分数（EF）<52.5%、SE阳性、缺血性ECG反应、高血压病史和年龄。
SE阳性提供了有用的预后信息，同时考虑静息室壁运动、负荷ECG反应和多巴酚丁胺EF可增强该信息。
