Sicari R, Landi P, Picano E, Pirelli S, Chiarandà G, Previtali M, Seveso G, Gandolfo N, Margaria F, Magaia O, Minardi G, Mathias W
CNR Institute of Clinical Physiology, Pisa, Italy.
Eur Heart J. 2002 Jul;23(13):1030-7. doi: 10.1053/euhj.2001.3072.
The aim of the present study was to assess the relative prognostic value of clinical variables, the exercise electrocardiography test and the pharmacological stress echocardiography test either with dipyridamole or dobutamine early after a first uncomplicated acute myocardial infarction in a large, multicentre, prospective study.
Seven hundred and fifty-nine in-hospital patients (age=56+/-10 years) with a recent and first clinical uncomplicated myocardial infarction, with baseline echocardiographic findings of satisfactory quality, an interpretable ECG and able to exercise underwent a resting 2D echocardiogram, a pharmacological stress test with either dipyridamole or dobutamine and an exercise electrocardiography test at a mean of 10 days from the infarction; they were followed-up for a median of 10 months. During the follow-up, there were 13 deaths, 23 non-fatal myocardial infarctions and 59 re-hospitalizations for unstable angina. When all spontaneous events were considered, with multivariate analysis, the difference between the wall motion score index at rest and peak stress (delta wall motion score index), and exercise duration were independent predictors of future spontaneous events (relative risk 7.2; 95% CI=2.73-19.1; P=0.000; relative risk 1.1, 95% CI=1.02-1.18; P=0.008, respectively). Kaplan-Meier survival estimates showed a better outcome for those patients with a negative pharmacological stress echocardiography test compared to patients with low dose positivity (94.7 vs 74.8%, P=0.000).
Stress echocardiography tests provide stronger information than historical and exercise electrocardiography test variables. Pharmacological echocardiography as well as the exercise ECG is able to predict all spontaneously occurring events when the presence as well as the timing, severity, and extension of stress-induced wall motion abnormalities are considered.
本研究旨在通过一项大型多中心前瞻性研究，评估在首次无并发症急性心肌梗死后早期，临床变量、运动心电图试验以及双嘧达莫或多巴酚丁胺药物负荷超声心动图试验的相对预后价值。
759例住院患者（年龄56±10岁）近期首次发生临床无并发症心肌梗死，基线超声心动图检查结果质量良好，心电图可解读且能够进行运动，在心肌梗死后平均10天接受静息二维超声心动图、双嘧达莫或多巴酚丁胺药物负荷试验以及运动心电图试验；随访中位数为10个月。随访期间，有13例死亡、23例非致命性心肌梗死以及59例因不稳定型心绞痛再次住院。当考虑所有自发事件时，多因素分析显示，静息和峰值负荷时的室壁运动评分指数差值（室壁运动评分指数差值）以及运动持续时间是未来自发事件的独立预测因素（相对风险7.2；９５％可信区间＝2.73 - 19.1；P = 0.000；相对风险1.1，９５％可信区间＝1.02 - 1.18；P = 0.008）。Kaplan-Meier生存估计显示，与低剂量阳性患者相比，药物负荷超声心动图试验阴性的患者预后更好（94.7％对74.8％，P = 0.000）。
负荷超声心动图试验比传统及运动心电图试验变量提供的信息更强。当考虑负荷诱发的室壁运动异常的存在、时间、严重程度和范围时，药物负荷超声心动图以及运动心电图能够预测所有自发发生的事件。
