Valley Health System, Ridgewood, New Jersey, USA.
Am J Cardiol. 2012 Jan 15;109(2):153-8. doi: 10.1016/j.amjcard.2011.08.023. Epub 2011 Oct 21.
The purpose of this study was to evaluate the prognostic value of stress echocardiography in patients with angiographically significant coronary artery disease (CAD). Two hundred sixty patients (mean age 63 ± 10 years, 58% men) who underwent stress echocardiography (41% treadmill, 59% dobutamine) and coronary angiography within 3 months and without intervening coronary revascularization were evaluated. All patients had significant CAD as defined by coronary stenosis ≥70% in major epicardial vessels or branches (45% had single-vessel disease, and 55% had multivessel disease). The left ventricle was divided into 16 segments and scored on a 5-point scale of wall motion. Patients with abnormal results on stress echocardiography were defined as those with stress-induced ischemia (increase in wall motion score of ≥1 grade). Follow-up (3.1 ± 1.2 years) for nonfatal myocardial infarction (n = 23) and cardiac death (n = 6) was obtained. In patients with angiographically significant CAD, stress echocardiography effectively risk stratified normal (no ischemia, n = 91) in contrast to abnormal (ischemia, n = 169) groups for cardiac events (event rate 1.0%/year vs 4.9%/year, p = 0.01). Multivariate logistic regression analysis identified multivessel CAD (hazard ratio 2.53, 95% confidence interval 1.16 to 5.51, p = 0.02) and number of segments in which ischemia was present (hazard ratio 4.31, 95% confidence interval 1.29 to 14.38, p = 0.01) as predictors of cardiac events. A Cox proportional-hazards model for cardiac events showed small, significant incremental value of stress echocardiography over coronary angiography (p = 0.02) and the highest global chi-square value for both (p = 0.004). In conclusion, in patients with angiographically significant CAD, (1) normal results on stress echocardiography conferred a benign prognosis (event rate 1.0%/year), and (2) stress echocardiographic results (no ischemia vs ischemia) added incremental prognostic value to coronary angiographic results, and (3) stress echocardiography and coronary angiography together provided additive prognostic value, with the highest global chi-square value.
这项研究的目的是评估血管造影显示有显著冠状动脉疾病（CAD）患者中应激超声心动图的预后价值。在 3 个月内接受了应激超声心动图（41%为踏车运动，59%为多巴酚丁胺）和冠状动脉造影检查且没有接受冠状动脉血运重建的 260 例患者（平均年龄 63±10 岁，58%为男性）接受了评估。所有患者均有显著 CAD，定义为主要心外膜血管或分支的冠状动脉狭窄≥70%（45%为单支血管病变，55%为多支血管病变）。左心室被分为 16 个节段，并根据壁运动的 5 分制进行评分。应激超声心动图结果异常的患者定义为有应激诱导缺血（壁运动评分增加≥1 级）。获得了非致命性心肌梗死（n=23）和心脏死亡（n=6）的 3.1±1.2 年随访结果。在有显著 CAD 的患者中，应激超声心动图有效地对正常（无缺血，n=91）和异常（缺血，n=169）两组进行了危险分层，用于预测心脏事件（事件发生率分别为 1.0%/年和 4.9%/年，p=0.01）。多变量逻辑回归分析确定多支血管 CAD（危险比 2.53，95%置信区间 1.16 至 5.51，p=0.02）和存在缺血的节段数量（危险比 4.31，95%置信区间 1.29 至 14.38，p=0.01）是心脏事件的预测因素。心脏事件的 Cox 比例风险模型显示，应激超声心动图相对于冠状动脉造影具有较小但显著的附加价值（p=0.02），并且对于两者来说，最高的全局 chi-square 值（p=0.004）。总之，在有显著 CAD 的患者中，（1）应激超声心动图结果正常提示预后良好（事件发生率为 1.0%/年），（2）应激超声心动图结果（无缺血与缺血）增加了冠状动脉造影结果的附加预后价值，（3）应激超声心动图和冠状动脉造影联合提供了附加的预后价值，全局 chi-square 值最高。
