多巴酚丁胺负荷超声心动图对老年人死亡率的长期预测

Long-term prediction of mortality in elderly persons by dobutamine stress echocardiography.

作者信息

Biagini Elena, Elhendy Abdou, Schinkel Arend F L, Rizzello Vittoria, Bax Jeroen J, Sozzi Fabiola B, Kertai Miklos D, van Domburg Ron T, Krenning Boudewijn J, Branzi Angelo, Rapezzi Claudio, Simoons Maarten L, Poldermans Don

机构信息

Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.

出版信息

J Gerontol A Biol Sci Med Sci. 2005 Oct;60(10):1333-8. doi: 10.1093/gerona/60.10.1333.

DOI:10.1093/gerona/60.10.1333

PMID:16282570

Abstract

BACKGROUND

Dobutamine stress echocardiography (DSE) was shown to provide incremental prognostic information. However, its role in the prediction of mortality in elderly persons is not well defined. We assessed the value of DSE in the prediction of mortality and hard cardiac events during long-term follow-up in patients older than 65 years.

METHODS

We studied 1434 patients >65 years old (mean age 72 +/- 3 years) who underwent DSE for evaluation of coronary artery disease. Ischemia was defined as new or worsening wall motion abnormalities. Follow-up events were total mortality and hard cardiac events (cardiac mortality and nonfatal myocardial infarction). Multivariable Cox regression analysis was used to identify the independent predictors of follow-up events.

RESULTS

Ischemia was detected in 675 patients (47%). Five hundred six patients (35%) had a normal study, and 253 (18%) had fixed wall motion abnormalities. During a mean follow-up of 6.5 years, 532 (37%) deaths occurred, of which 249 (17%) were due to cardiac causes. A nonfatal myocardial infarction occurred in 45 patients (3%). Independent predictors of all-cause mortality in a multivariate analysis model were age (hazard ratio [HR] 1.06; 95% confidence interval [CI], 1.05-1.08), male sex (HR 1.5; 95% CI, 1.2-1.8), hypertension (HR 1.2; 95% CI, 1.1-1.4), smoking (HR 1.3; 95% CI, 1.1-1.6), diabetes (HR 1.4; 95% CI, 1.1-1.8), rest wall motion abnormalities (HR 1.07; 95% CI, 1.06-1.09), and ischemia (HR 1.3; 95% CI, 1.1-1.6). Independent predictors of hard cardiac events were age (HR 1.07; 95% CI, 1.05-1.09), male sex (HR 1.3; 95% CI, 1.1-1.7), smoking (HR 1.3; 95% CI, 1.1-1.6), diabetes (HR 1.6; 95% CI, 1.2-2.2), rest wall motion abnormalities (HR 1.13; 95% CI, 1.12-1.16), and ischemia (HR 2.1; 95% CI, 1.5-2.8).

CONCLUSION

DSE provides independent prognostic information to predict all-cause mortality and hard cardiac events in elderly patients.

摘要

背景

多巴酚丁胺负荷超声心动图（DSE）已被证明可提供额外的预后信息。然而，其在预测老年人死亡率方面的作用尚未明确界定。我们评估了DSE在预测65岁以上患者长期随访期间死亡率和严重心脏事件中的价值。

方法

我们研究了1434例年龄>65岁（平均年龄72±3岁）因评估冠状动脉疾病而接受DSE检查的患者。缺血定义为新出现或加重的室壁运动异常。随访事件包括全因死亡率和严重心脏事件（心脏性死亡和非致命性心肌梗死）。采用多变量Cox回归分析来确定随访事件的独立预测因素。

结果

675例患者（47%）检测到缺血。506例患者（35%）检查结果正常，253例患者（18%）存在固定的室壁运动异常。在平均6.5年的随访期间，发生了532例（37%）死亡，其中249例（17%）是由心脏原因导致的。45例患者（3%）发生了非致命性心肌梗死。多变量分析模型中全因死亡率的独立预测因素为年龄（风险比[HR]1.06；95%置信区间[CI]，1.05 - 1.08）、男性（HR 1.5；95% CI，1.2 - 1.8）、高血压（HR 1.2；95% CI，1.1 - 1.4）、吸烟（HR 1.3；95% CI，1.1 - 1.6）、糖尿病（HR 1.4；95% CI，1.1 - 1.8）、静息时室壁运动异常（HR 1.07；95% CI，1.06 - 1.09）和缺血（HR 1.3；95% CI，1.1 - 1.6）。严重心脏事件的独立预测因素为年龄（HR 1.07；95% CI，1.05 - 1.09）、男性（HR 1.3；95% CI，1.1 - 1.7）、吸烟（HR 1.3；95% CI，1.1 - 1.6）、糖尿病（HR 1.6；95% CI，1.2 - 2.2）、静息时室壁运动异常（HR 1.13；95% CI，1.12 - 1.16）和缺血（HR 2.1；95% CI，1.5 - 2.8）。