Samiei Niloufar, Parsaee Mozhgan, Pourafkari Leili, Tajlil Arezou, Pasbani Yeganeh, Rafati Ali, Nader Nader D
Heart Valve Research Center, Rajaie Cardiovascular Medical & Research Center, Tehran, Iran.
Echocardiography Research Center, Rajaie Cardiovascular Medical & Research Center, Tehran, Iran.
J Cardiovasc Thorac Res. 2019;11(2):85-94. doi: 10.15171/jcvtr.2019.16. Epub 2019 Jun 13.
Stress echocardiography is a safe and cost-effective method of evaluating the patients with suspected coronary artery disease (CAD). However, the risk factors of an adverse cardiovascular event after a normal exercise (ESE) or dobutamine (DSE) stress echocardiography are not well established. A cohort of 705 patients without previous history of CAD and a negative ESE/DSE was studied. All studies were performed in a high-volume echocardiologic laboratory and interpreted by two experienced echocardiography-trained cardiologists. Patients with inconclusive studies and those with an evidence of myocardial ischemia were excluded. Demographic, echocardiographic and hemodynamic findings were recorded. Patients were followed for at least 2 years. Independent predictors of major adverse cardiovascular events (MACE) were determined by regression analysis. During a period of 55.7±17.5 months, MACE occurred in 35 (5.0%) of patients. Negative predictive value (NPV) of DSE was 89.2%, which was significantly less than 96.5% for ESE in predicting the occurrence of MACE ( = 0.001). MACE occurred more frequently among older (≥65 years) men with preexisting diabetes, hypertension, and/or hyperlipidemia. During ESE, a higher maximum blood pressure*heart rate product for the achieved level of metabolic equivalent (METS) of tasks was also an independent predictor of MACE. Inability of patients to undergo traditional ESE that led to the choice of using DSE alternative reduces the NPV of the stress echocardiography among patients without previous history of CAD. A modest rise of heart rate and blood pressure in response to increased level of activity serves as favorable prognostic value and improves the NPV of stress echocardiography.
负荷超声心动图是评估疑似冠心病（CAD）患者的一种安全且经济有效的方法。然而，运动（ESE）或多巴酚丁胺（DSE）负荷超声心动图检查结果正常后发生不良心血管事件的危险因素尚未完全明确。对705例无CAD病史且ESE/DSE检查结果为阴性的患者进行了一项队列研究。所有检查均在一个大容量超声心动图实验室进行，并由两名经验丰富的经过超声心动图培训的心脏病专家解读。排除检查结果不确定的患者以及有心肌缺血证据的患者。记录人口统计学、超声心动图和血流动力学检查结果。对患者进行至少2年的随访。通过回归分析确定主要不良心血管事件（MACE）的独立预测因素。在55.7±17.5个月的随访期内，35例（5.0%）患者发生了MACE。DSE的阴性预测值（NPV）为89.2%，在预测MACE发生方面显著低于ESE的96.5%（P = 0.001）。在患有糖尿病、高血压和/或高脂血症的老年（≥65岁）男性中，MACE的发生更为频繁。在ESE期间，达到的代谢当量（METS）水平下较高的最大血压*心率乘积也是MACE的独立预测因素。患者无法进行传统ESE而选择使用DSE替代方案会降低无CAD病史患者中负荷超声心动图的NPV。随着活动水平增加，心率和血压适度升高具有良好的预后价值，并可提高负荷超声心动图的NPV。
