Department of Cardiology and Echocardiography Laboratory, Royal Brompton and Harefield NHS Trust, London, United Kingdom.
JACC Cardiovasc Imaging. 2013 Sep;6(9):987-92. doi: 10.1016/j.jcmg.2013.04.011.
We examined the prognostic value of stress echocardiography appropriateness criteria for evaluation of valvular heart disease in 100 consecutive patients. Of the studies, 49%, 36%, and 15% were classified as appropriate, uncertain, and inappropriate, respectively. Over a median of 12.6 months, 24 events (12 deaths and 12 heart failure admissions) occurred. The 12-month event-free survival was significantly reduced in patients with appropriate or uncertain studies compared with patients with inappropriate studies (p = 0.04 and p = 0.005, respectively). There was no survival difference between patients with an appropriate or uncertain indication (p = 0.1). The only independent predictors of events were a positive stress echocardiogram (hazard ratio: 15.5, p < 0.0001) and left ventricular ejection fraction (hazard ratio: 0.95, p = 0.02). The appropriateness criteria for evaluation of valvular heart disease provide the ability to differentiate between patients at high- (appropriate group) and low- (inappropriate group) risk of cardiac events. Reclassification of the uncertain group may improve the differential value of these criteria.
我们在 100 例连续患者中检查了应激超声心动图适宜性标准对瓣膜性心脏病评估的预后价值。在这些研究中，分别有 49%、36%和 15%被归类为适宜、不确定和不适宜。在中位数为 12.6 个月的随访中，发生了 24 起事件（12 例死亡和 12 例心力衰竭入院）。与不适宜研究的患者相比，适宜或不确定研究的患者 12 个月无事件生存率显著降低（p = 0.04 和 p = 0.005）。在有适宜或不确定适应证的患者之间没有生存差异（p = 0.1）。事件的唯一独立预测因素是阳性应激超声心动图（危险比：15.5，p < 0.0001）和左心室射血分数（危险比：0.95，p = 0.02）。瓣膜性心脏病评估的适宜性标准能够区分高风险（适宜组）和低风险（不适宜组）的心脏事件患者。不确定组的重新分类可能会提高这些标准的差异价值。
