Innocenti Francesca, Caldi Francesca, Tassinari Irene, Agresti Chiara, Burgisser Costanza, Fattirolli Francesco, Baldereschi Giorgio Jacopo, Marchionni Niccolò, Masotti Giulio, Pini Riccardo
Department of Critical Care Medicine and Surgery, Unit of Geriatric Cardiology, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Echocardiography. 2009 Jan;26(1):1-9. doi: 10.1111/j.1540-8175.2008.00752.x. Epub 2008 Nov 1.
The aim of this study was to compare the feasibility of dobutamine stress echocardiography (DSE) and exercise stress test (EST) between patients in different age groups and to evaluate their proportional prognostic value in a population with established coronary artery disease (CAD).
The study sample included 323 subjects, subdivided in group 1 (G1), comprising 246 patients aged <75 years, and group 2 (G2), with 77 subjects aged >or=75 years. DSE and EST were performed before enrollment in a cardiac rehabilitation program; for prognostic assessment, end points were all-cause mortality and hard cardiac events (cardiac death or nonfatal myocardial infarction).
During DSE, G2 patients showed worse wall motion score index (WMSI), but the test was stopped for complications in a comparable proportion of cases (54 G1 and 19 G2 patients, P = NS). EST was inconclusive in similarly high proportion of patients in both groups (76% in G1 vs. 84% in G2, P = NS); G2 patients reached a significantly lower total workload (6 +/- 1.6 METs in G1 vs. 5 +/- 1.2 METs in G2, P < 0.001). At multivariate analysis, a lower peak exercise capacity (HR 0.566, CI 0.351-0.914, P = 0.020) was associated with higher mortality, while a high-dose WMSI >2 (HR 5.123, CI 1.559-16.833, P = 0.007), viability (HR 3.354, CI 1.162-9.678, P = 0.025), and nonprescription of beta-blockers (HR 0.328, CI 0.114-0.945, P = 0.039) predicted hard cardiac events.
In patients with known CAD, EST and DSE maintain a significant prognostic role in terms of peak exercise capacity for EST and of presence of viability and an extensive wall motion abnormalities at peak DSE.
本研究旨在比较不同年龄组患者多巴酚丁胺负荷超声心动图（DSE）和运动负荷试验（EST）的可行性，并评估它们在已确诊冠心病（CAD）人群中的相对预后价值。
研究样本包括323名受试者，分为第1组（G1），由246名年龄<75岁的患者组成，以及第2组（G2），有77名年龄≥75岁的受试者。在纳入心脏康复计划之前进行DSE和EST；为了进行预后评估，终点为全因死亡率和严重心脏事件（心源性死亡或非致命性心肌梗死）。
在DSE期间，G2组患者的壁运动评分指数（WMSI）较差，但两组因并发症而终止检查的比例相当（G1组54例，G2组19例，P =无显著性差异）。两组中类似高比例的患者EST结果不明确（G1组为76%，G2组为84%，P =无显著性差异）；G2组患者达到的总工作量显著较低（G1组为6±1.6代谢当量，G2组为5±1.2代谢当量，P <0.001）。在多变量分析中，较低的峰值运动能力（HR 0.566，CI 0.351 - 0.914，P = 0.020）与较高的死亡率相关，而高剂量WMSI>2（HR 5.123，CI 1.559 - 16.833，P = 0.007）、存活心肌（HR 3.354，CI 1.162 - 9.678，P = 0.025）以及未使用β受体阻滞剂（HR 0.328，CI 0.114 - 0.945，P = 0.
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