Rossi Andrea, Moccetti Tiziano, Faletra Francesco, Cattaneo Paolo, Rossi Mariagrazia, Pasotti Elena, Fantoni Cecilia, Anzà Claudio, Baravelli Massimo
Department of Cardiology, Cardiocentro Ticino, Lugano, Switzerland.
Int J Cardiovasc Imaging. 2008 Jun;24(5):495-502. doi: 10.1007/s10554-007-9289-6. Epub 2007 Dec 22.
Patients with previous myocardial revascularization, even if symptom-free, remain at risk of subsequent cardiac events, so that a non-invasive tool able to stratify this population is wishful.
To assess the prognostic value of dipyridamole stress echocardiography (DipSE) in a population of asymptomatic patients following complete myocardial revascularization, either by coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI).
We retrospectively evaluated 104 consecutive symptom-free patients (mean age 67+/-9.3 years, 75 males) with recent (<12 months) complete myocardial revascularization (48% PCI, 52% CABG) undergoing DipSE. Ischemia was defined as the onset of a new or worsening wall motion abnormality during DipSE. The composite end point of the study was cardiac death and non-fatal acute coronary syndrome.
Myocardial ischemia was identified in 23 patients (22.1%). During a mean follow up of 21 months, 7 (30.4%) out of these patients suffered cardiac events. Among the remaining 81 patients (77.9%) with negative DipSE results, 7 (8.6%) experienced cardiac events. At multivariable analysis only a positive DipSE (odds ratio 3.9, P=0.03), wall motion score index at peak of stress (OR 3.6, P=0.04) and a prior myocardial infarction (odds ratio 3.5, P=0.04) achieved statistical significance for cardiac events. Moreover, DipSE effectively stratified patients into a high and low risk group according to presence of inducible ischemia (event rate per year 16% vs 4.8%, P=0.02).
DipSE yields appropriate risk stratification and provides incremental prognostic value over clinical variables even in asymptomatic patients with prior complete myocardial revascularization. A negative DipSE portends a benign prognosis (<5% event rate/year) in such population.
既往接受过心肌血运重建的患者，即便无症状，仍有发生后续心脏事件的风险，因此，一种能够对该人群进行危险分层的非侵入性工具是人们所期望的。
评估双嘧达莫负荷超声心动图（DipSE）在接受冠状动脉旁路移植术（CABG）或经皮冠状动脉介入治疗（PCI）实现完全心肌血运重建的无症状患者人群中的预后价值。
我们回顾性评估了104例近期（<12个月）接受完全心肌血运重建（48%为PCI，52%为CABG）且无症状的连续患者（平均年龄67±9.3岁，男性75例），这些患者均接受了DipSE检查。缺血定义为DipSE检查期间出现新的或加重的室壁运动异常。本研究的复合终点为心源性死亡和非致死性急性冠状动脉综合征。
23例患者（22.1%）发现心肌缺血。在平均21个月的随访期间，这些患者中有7例（30.4%）发生了心脏事件。在其余81例DipSE结果为阴性的患者（77.9%）中，7例（8.6%）发生了心脏事件。多变量分析显示，仅DipSE结果阳性（比值比3.9，P=0.03）、负荷峰值时的室壁运动评分指数（OR 3.6，P=0.04）和既往心肌梗死（比值比3.5，P=0.04）对心脏事件具有统计学意义。此外，DipSE根据是否存在诱发性缺血有效地将患者分为高危和低危组（每年事件发生率分别为16%和4.8%，P=0.02）。
即使在既往已实现完全心肌血运重建的无症状患者中，DipSE也能进行适当的危险分层，并提供优于临床变量的增量预后价值。DipSE结果为阴性预示该人群预后良好（每年事件发生率<5%）。
