Universidade Federal de Sergipe, Aracaju, SE, Brazil.
Arq Bras Cardiol. 2013 Jul;101(1):35-42. doi: 10.5935/abc.20130124. Epub 2013 Jun 14.
Exercise test (ET) is the preferred initial noninvasive test for the diagnosis and risk stratification of coronary artery disease (CAD), however, its lower sensitivity may fail to identify patients at greater risk of adverse events.
To assess the value of stress echocardiography (SE) for predicting all-cause mortality and major cardiac events (MACE) in patients with intermediate pretest probability of CAD and a normal ET.
397 patients with intermediate CAD pretest probability , estimated by the Morise score, and normal ET who underwent SE were studied. The patients were divided into two groups according to the absence (G1) or presence (G2) of myocardial ischemia on SE .End points evaluated were all-cause mortality and MACE, defined as cardiac death and nonfatal acute myocardial infarction (AMI).
G1 group was comprised of 329 (82.8%) patients. The mean age of the patients was 57.37 ± 11 years and 44.1% were male. During a mean follow-up of 75.94 ± 17.24 months, 13 patients died, three of them due to cardiac causes, and 13 patients suffered nonfatal AMI. Myocardial ischemia remained an independent predictor of MACE (HR 2.49; [CI] 95% 1.74-3.58). The independent predictors for all-cause mortality were male gender (HR 9.83; [CI] 95% 2.15-44.97) and age over 60 years (HR 4.57; [CI] 95% 1.39-15.23).
Positive SE for myocardial ischemia is a predictor of MACE in the studied sample, which helps to identify a subgroup of patients at higher risk of events despite having normal ET.
运动试验（ET）是诊断和分层冠状动脉疾病（CAD）的首选初始非侵入性检查，但它的敏感性较低，可能无法识别出发生不良事件风险更高的患者。
评估负荷超声心动图（SE）在 CAD 中检测概率为中度且 ET 正常的患者中预测全因死亡率和主要心脏事件（MACE）的价值。
研究了 397 例 CAD 中检测概率中度，Morise 评分估计，SE 正常的患者。根据 SE 上是否存在（G2）或不存在（G1）心肌缺血，将患者分为两组。评估的终点是全因死亡率和 MACE，定义为心脏死亡和非致命性急性心肌梗死（AMI）。
G1 组包括 329 例（82.8%）患者。患者的平均年龄为 57.37 ± 11 岁，44.1%为男性。平均随访 75.94 ± 17.24 个月期间，有 13 名患者死亡，其中 3 人死于心脏原因，有 13 名患者发生非致命性 AMI。心肌缺血仍然是 MACE 的独立预测因素（HR 2.49；[CI] 95% 1.74-3.58）。全因死亡率的独立预测因素为男性（HR 9.83；[CI] 95% 2.15-44.97）和年龄超过 60 岁（HR 4.57；[CI] 95% 1.39-15.23）。
SE 阳性提示心肌缺血是研究样本中 MACE 的预测因素，它有助于识别出 ET 正常但发生事件风险较高的亚组患者。
