D'Andrea Antonello, Severino Sergio, Caso Pio, Fusco Angela, Lo Piccolo Rosalia, Liccardo Biagio, Forni Alberto, Di Salvo Giovanni, Scherillo Marino, Mininni Nicola, Calabrò Raffaele
Department of Cardiology, Second University of Naples, Italy.
Ital Heart J. 2005 Jul;6(7):565-72.
The aim of this study was to assess the long-term predictive values of supine bicycle exercise stress echocardiography (ESE), and the ESE additional role compared to other traditional clinical and rest echocardiographic variables, in 607 patients with low, intermediate and high pretest risk of cardiac events.
Clinical status and long-term outcome were assessed for a mean period of 46 months (range 12-60 months). ESE was performed for the diagnosis of suspected coronary artery disease (CAD) in 267 patients (43.9%), and for risk stratification of known CAD in 340 patients (56.1%). At baseline, the mean value of wall motion score index (WMSI) was 1.22 +/- 0.36, and the mean left ventricular ejection fraction was 58.5 +/- 10.9%.
ESE was positive for ischemia in 210 patients (34.9%), while ECG was suggestive for ischemia in 157 patients (25.8%). During the test only 97 patients (15.9%) experienced angina. At peak effort, the mean WMSI was 1.38 +/- 0.46. A low workload was achieved by 158 patients (26.1%). During the follow-up period there were 222 events, including 82 hard events (36.9%), 48 deaths (21.6%) and 34 acute non-fatal myocardial infarction (15.3%). At stepwise multivariate model, cigarette smoking (p < 0.01), peak WMSI (p < 0.001), ESE positive for ischemia (p < 0.001) and low workload (p < 0.01) were the only independent predictors of cardiac death, while positive ESE, peak WMSI, angina during the test and hypercholesterolemia were the only independent determinants of hard cardiac events. The cumulative 5-year mean survival rate according to ESE response was 95.9% in patients with negative ESE, and 83.7% in patients with positive ESE (log rank 13.6; p < 0.00001).
ESE yields prognostic information in known or suspected CAD, especially in patients with intermediate pretest risk level. The combined evaluation of clinical variables and other ESE variables, such as peak WMSI and exercise capacity, may further select patients at greatest risk of cardiac death in the overall population.
本研究旨在评估607例心脏事件发生前低、中、高风险患者中，仰卧位自行车运动负荷超声心动图（ESE）的长期预测价值，以及与其他传统临床和静息超声心动图变量相比ESE的额外作用。
对患者的临床状况和长期预后进行了平均46个月（范围12 - 60个月）的评估。267例患者（43.9%）进行ESE以诊断疑似冠状动脉疾病（CAD），340例患者（56.1%）进行ESE以对已知CAD进行危险分层。基线时，室壁运动评分指数（WMSI）的平均值为1.22±0.36，左心室射血分数的平均值为58.5±10.9%。
210例患者（34.9%）ESE显示心肌缺血阳性，而157例患者（25.8%）心电图提示心肌缺血。测试期间仅有97例患者（15.9%）发生心绞痛。运动高峰时，平均WMSI为1.38±0.46。158例患者（26.1%）运动负荷较低。随访期间发生222起事件，包括82起严重事件（36.9%）、48例死亡（21.6%）和34例急性非致命性心肌梗死（15.3%）。在逐步多变量模型中，吸烟（p < 0.01）、运动高峰WMSI（p < 0.001）、ESE心肌缺血阳性（p < 0.001）和运动负荷低（p < 0.01）是心脏死亡的唯一独立预测因素，而ESE阳性、运动高峰WMSI、测试期间心绞痛和高胆固醇血症是严重心脏事件的唯一独立决定因素。根据ESE反应，ESE阴性患者的5年累积平均生存率为95.9%，ESE阳性患者为83.7%（对数秩检验13.6；p < 0.00001）。
ESE可为已知或疑似CAD患者提供预后信息，尤其是在事件发生前风险水平为中等的患者中。综合评估临床变量和其他ESE变量（如运动高峰WMSI和运动能力），可能会在总体人群中进一步筛选出心脏死亡风险最高的患者。
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