High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
Am J Emerg Med. 2014 Jul;32(7):731-6. doi: 10.1016/j.ajem.2014.03.026. Epub 2014 Mar 27.
The aims of this study were to evaluate the long-term prognostic value of stress echocardiography (SE) in patients evaluated in emergency department (ED) and to determine SE parameters that best predicted outcome.
Between June 2008 and July 2012, 626 patients with an episode of spontaneous chest pain underwent SE (exercise stress echocardiography or dobutamine stress echocardiography [DSE]). Between December 2012 and January 2013, all patients were contacted to verify the occurrence of cardiac events. Patients were divided in 3 subgroups according to peak stress Wall Motion Score Index (pWMSI): normal peak wall motion (pWMSI, 1; group A1), mild to moderate peak asynergy (pWMSI, 1.1-1.7; group A2), and severe peak asynergy (pWMSI, >1.7; group A3).
Stress echocardiography showed inducible ischemia in 159 patients (25%); it was negative in 425 (68%) and inconclusive in 42 (7%). Patients with cardiac events more frequently showed inducible ischemia (50% vs 26%; P = .015) compared with patients with good prognosis; a normal SE (14% vs 61%) was significantly less common. At a multivariate regression analysis, an increased pWMSI (relative risk: 9.816, 95% confidence interval: 3.665-26.290; P < .0001) was independently associated with a bad outcome. Cumulative event-free survival was significantly worse with an increasing degree of peak wall motion asynergy (99% in group A1; 96%, group A2; and 88% in group A3; P = .011 between A1 and A2 groups, P = .012 between A2 and A3 groups, and P < .0001 between A1 and A3 groups).
Stress echocardiography showed an optimal prognostic value among ED patients evaluated for chest pain. The presence of an extensive asynergic area at peak stress was associated with an adverse prognosis.
本研究旨在评估急诊患者行应激超声心动图（SE）检查的长期预后价值，并确定预测结局的最佳 SE 参数。
2008 年 6 月至 2012 年 7 月期间，626 例自发性胸痛患者行 SE（运动负荷超声心动图或多巴酚丁胺负荷超声心动图[DSE]）检查。2012 年 12 月至 2013 年 1 月期间，所有患者均被联系以确认是否发生心脏事件。根据峰值应激壁运动指数（pWMSI）将患者分为 3 个亚组：正常峰值壁运动（pWMSI，1；A1 组）、轻度至中度峰值节段性运动不良（pWMSI，1.1-1.7；A2 组）和严重峰值节段性运动不良（pWMSI，>1.7；A3 组）。
SE 检查显示 159 例（25%）患者存在可诱导缺血，425 例（68%）患者 SE 检查结果为阴性，42 例（7%）患者 SE 检查结果不确定。与预后良好的患者相比，发生心脏事件的患者更常出现可诱导缺血（50%比 26%；P=0.015），正常 SE 检查结果（14%比 61%）明显较少。多变量回归分析显示，pWMSI 增加（比值比：9.816，95%置信区间：3.665-26.290；P<0.0001）与不良结局独立相关。随着峰值壁运动不良程度的增加，累积无事件生存率显著下降（A1 组为 99%；A2 组为 96%；A3 组为 88%；A1 组与 A2 组之间差异有统计学意义，P=0.011；A2 组与 A3 组之间差异有统计学意义，P=0.012；A1 组与 A3 组之间差异有统计学意义，P<0.0001）。
SE 检查在因胸痛就诊的急诊患者中具有最佳的预后价值。峰值时广泛的节段性运动不良区域与不良预后相关。
