Hawthorne Katie M, Johri Amer M, Malhotra Rajeev, Hung Judy, Baggish Aaron, Picard Michael H
Division of Cardiology and Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston MA, USA; Authors contributed equally to writing of manuscript.
Division of Cardiology and Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston MA, USA.
Cardiol Res. 2012 Apr;3(2):73-79. doi: 10.4021/cr154w. Epub 2012 Mar 20.
Non-diagnostic dobutamine stress echocardiography (ndDSE, failure to achieve 85% of maximal predicted heart rate (HR) without evidence of inducible ischemia) is an important limitation affecting quality of DSE testing. The objectives of this study were to identify the clinical variables associated with a non-diagnostic Dobutamine Stress Echocardiogram (ndDSE) and further evaluate the patterns of subsequent testing for myocardial ischemia.
Consecutive DSE's over a 17 month period (January 2008 to June 2009) were studied. Baseline demographics, medical history, and vital signs were collected. Subsequent testing was determined for up to 6 months after the initial DSE. Univariate and multivariate logistic regression analysis was performed to identify clinical factors associated with ndDSE.
Of 467 total DSE, 314 (67%) were negative for ischemia, 69 (15%) were positive, and 84 (18%) were ndDSE. Of those recommended for further nuclear MPI testing 12 (14%) had an ndDSE compared to 16 (4%) patients with a diagnostic DSE (P = 0.001). Fifty percent of the ndDSE nuclear MPI tests were positive for ischemia. In the univariate analysis, Diabetes Mellitus (DM; P = 0.003), calcium channel antagonist (CCA) use (P = 0.047), Hypertension (HTN; P = 0.06), low baseline HR (P < 0.001), and younger age group (P = 0.02) were predictive of ndDSE. Of these, all except CCA use remained independent predictors of ndDSE in multivariate analysis. A 4 variable model for predicting ndDSE was developed from the multivariate logistic regression displayed in Table 1 (age and baseline HR were categorized and scored 0-2; DM and HTN were scored as 0 (absent) or 1 (present)). Figure 2 demonstrates how risk of ndDSE correlated with a higher score, with each increment having an odds ratio of 2.1 (P < 0.001).
DM, HTN, younger age, and lower baseline HR affect the quality of DSE testing, resulting in non-diagnostic tests. A model combining these factors can identify patients most likely to have this outcome. Identification of this cohort may improve referral patterns and improve the quality of stress testing.
非诊断性多巴酚丁胺负荷超声心动图（ndDSE，未达到最大预测心率（HR）的85%且无诱发缺血证据）是影响多巴酚丁胺负荷超声心动图（DSE）检查质量的一个重要限制因素。本研究的目的是确定与非诊断性多巴酚丁胺负荷超声心动图（ndDSE）相关的临床变量，并进一步评估后续心肌缺血检查的模式。
对连续17个月（2008年1月至2009年6月）的DSE检查进行研究。收集基线人口统计学、病史和生命体征数据。确定初始DSE检查后长达6个月的后续检查情况。进行单因素和多因素逻辑回归分析，以确定与ndDSE相关的临床因素。
在总共467例DSE检查中，314例（67%）缺血检查结果为阴性，69例（15%）为阳性，84例（18%）为ndDSE。在被推荐进行进一步核素心肌灌注显像（MPI）检查的患者中，12例（14%）存在ndDSE，而诊断性DSE检查的患者中有16例（4%）（P = 0.001）。50%的ndDSE核素MPI检查缺血结果为阳性。在单因素分析中，糖尿病（DM；P = 0.003）、使用钙通道拮抗剂（CCA；P = 0.047）、高血压（HTN；P = 0.06）、低基线心率（P < 0.001）和较年轻年龄组（P = 0.02）可预测ndDSE。其中，除了使用CCA外，其他因素在多因素分析中仍是ndDSE的独立预测因素。根据表1中的多因素逻辑回归分析建立了一个预测ndDSE的四变量模型（年龄和基线心率进行分类并评分0 - 2；DM和HTN评分为0（无）或1（有））。图2显示了ndDSE风险如何与较高得分相关，每增加一分优势比为2.1（P < 0.001）。
DM、HTN、较年轻年龄和较低基线心率会影响DSE检查质量，导致检查结果为非诊断性。结合这些因素的模型可以识别最有可能出现这种结果的患者。识别这一队列患者可能会改善转诊模式并提高负荷试验的质量。
