Yao Siu Sun, Qureshi Ehtasham, Sherrid Mark V, Chaudhry Farooq A
Department of Medicine, Division of Cardiology, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York 10025, USA.
J Am Coll Cardiol. 2003 Sep 17;42(6):1084-90. doi: 10.1016/s0735-1097(03)00923-9.
The purpose of this study was to define appropriate parameters for risk stratification and prognosis in patients undergoing stress echocardiography.
Stress echocardiography is an established technique for the diagnosis of coronary artery disease. However, current data on risk stratification of patients undergoing stress echocardiography are limited.
We evaluated 1,500 patients (59 +/- 13 years old; 51% male) undergoing stress echocardiography (34% with treadmill exercise and 66% with dobutamine). Resting left ventricular ejection fraction (EF) and regional wall motion were assessed by the consensus of two echocardiographers. Follow-up (mean 2.7 +/- 1.0 years) for confirmed non-fatal myocardial infarction (n = 31) and cardiac death (n = 44) were performed.
By univariate analysis, both the peak wall motion score index (WMSI) (p < 0.0001) and EF (p < 0.0001) were significant predictors of cardiac events. Peak WMSI effectively risk stratified patients into low (0.9%/year), intermediate (3.1%/year), and high (5.2%/year) risk groups (p < 0.0001). A threshold of 45% EF provided further risk stratification of all WMSI groups. By multivariate logistic regression analysis, peak WMSI (relative risk [RR] 2.1, 95% confidence interval [CI] 1.0 to 4.4; p = 0.04) and EF (RR 1.0, 95% CI 0.9 to 1.0; p = 0.01) were both predictors of cardiac events.
Stress echocardiography yields prognostic information for risk stratification of patients with known or suspected ischemic heart disease. A normal stress echocardiographic study (peak WMSI = 1.0) confers a benign prognosis (0.9%/year cardiac event rate). Peak WMSI >1.7 and EF < or =45% are independent markers of patients at high risk of an adverse clinical outcome.
本研究旨在确定接受负荷超声心动图检查患者的风险分层及预后的合适参数。
负荷超声心动图是诊断冠状动脉疾病的一项成熟技术。然而，目前关于接受负荷超声心动图检查患者风险分层的数据有限。
我们评估了1500例接受负荷超声心动图检查的患者（年龄59±13岁；51%为男性）（34%进行平板运动，66%使用多巴酚丁胺）。由两名超声心动图医生共同评估静息左心室射血分数（EF）和节段性室壁运动。对确诊的非致命性心肌梗死（n = 31）和心源性死亡（n = 44）进行随访（平均2.7±1.0年）。
单因素分析显示，室壁运动评分指数峰值（WMSI）（p < 0.0001）和EF（p < 0.0001）均为心脏事件的显著预测指标。WMSI峰值有效地将患者分为低风险（每年0.9%）、中风险（每年3.1%）和高风险（每年5.2%）组（p < 0.0001）。EF阈值为45%可对所有WMSI组进行进一步的风险分层。多因素逻辑回归分析显示，WMSI峰值（相对风险[RR] 2.1，95%置信区间[CI] 1.0至4.4；p = 0.04）和EF（RR 1.0，95% CI 0.9至1.0；p = 0.01）均为心脏事件的预测指标。
负荷超声心动图可为已知或疑似缺血性心脏病患者的风险分层提供预后信息。负荷超声心动图检查正常（WMSI峰值 = 1.0）提示预后良好（每年心脏事件发生率0.9%）。WMSI峰值>1.7且EF≤45%是临床不良结局高风险患者的独立标志物。
