Elhendy A, Shub C, McCully R B, Mahoney D W, Burger K N, Pellikka P A
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Am J Med. 2001 Jul;111(1):18-23. doi: 10.1016/s0002-9343(01)00746-x.
The aim of this study was to determine whether exercise echocardiography provides incremental data for risk stratification of patients with a low pretest probability of coronary artery disease.
The study included patients referred for exercise echocardiography whose probability of coronary artery disease was 25% or less. We calculated an exercise wall motion score index (on a 1-5 scale), an indicator of the extent and severity of exercise-induced abnormalities. The primary outcomes of the study were subsequent cardiac events (cardiac death and nonfatal myocardial infarction).
We studied 571 men and 1047 women; their mean (+/- SD) age was 55 +/- 13 years. During a median follow-up of 3 years, there were 19 cardiac events (6 cardiac deaths and 13 nonfatal myocardial infarctions); an additional 37 patients underwent coronary revascularization. In a multivariate analysis of clinical, exercise electrocardiographic, and echocardiographic parameters, exercise wall motion score index (hazard ratio [HR] = 2.1 per 0.5 units; 95% confidence interval [CI]: 1.3 to 3.4), and age (HR = 2.0 per decade; 95% CI: 1.2-2.8) were independently associated with the risk of cardiac events. Although exercise echocardiographic variables contributed significantly (P = 0.01) to a model of the risk of adverse events, only 9 (47%) of the 19 patients with cardiac events were identified by an abnormal exercise echocardiogram.
Among patients with low pretest probability of coronary artery disease by clinical criteria, exercise echocardiography identifies some, but not all, patients at risk of future events. Because of the low event rate, routine application of exercise echocardiography in a patient with a low pretest probability does not appear to be cost-effective and therefore cannot be recommended.
本研究旨在确定运动超声心动图是否能为冠状动脉疾病预检概率较低的患者进行风险分层提供增量数据。
本研究纳入了因运动超声心动图检查而被转诊的患者，这些患者患冠状动脉疾病的概率为25%或更低。我们计算了运动壁运动评分指数（范围为1至5分），这是运动诱发异常的程度和严重程度的一个指标。本研究的主要结局是随后发生的心脏事件（心源性死亡和非致命性心肌梗死）。
我们研究了571名男性和1047名女性；他们的平均（±标准差）年龄为55±13岁。在中位随访3年期间，发生了19起心脏事件（6例心源性死亡和13例非致命性心肌梗死）；另有37例患者接受了冠状动脉血运重建。在对临床、运动心电图和超声心动图参数进行多变量分析时，运动壁运动评分指数（风险比[HR]=每0.5单位为2.1；95%置信区间[CI]：1.3至3.4）和年龄（HR=每十年为2.0；95%CI：1.2 - 2.8）与心脏事件风险独立相关。尽管运动超声心动图变量对不良事件风险模型有显著贡献（P = 0.01），但在19例发生心脏事件的患者中，只有9例（47%）通过运动超声心动图异常得以识别。
在临床标准显示冠状动脉疾病预检概率较低的患者中，运动超声心动图能识别出部分但并非全部有未来事件风险的患者。由于事件发生率较低，对预检概率较低的患者常规应用运动超声心动图似乎不具有成本效益，因此不推荐使用。
