Marwick T H, Mehta R, Arheart K, Lauer M S
Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195, USA.
J Am Coll Cardiol. 1997 Jul;30(1):83-90. doi: 10.1016/s0735-1097(97)00148-4.
This study prospectively compared the incremental prognostic benefit of exercise echocardiography with that of exercise testing in a large cohort.
Exercise echocardiography is widely accepted as a diagnostic tool, but the prognostic information provided by this test, incremental to clinical and stress testing evaluation, is ill-defined.
Clinical, exercise and echocardiographic variables were studied in a consecutive group of 500 patients undergoing exercise echocardiography. After exclusion of patients who underwent revascularization within 3 months of the stress test (n = 16, 3%) and those lost to follow-up (n = 21, 4%), the remaining 463 patients (mean [+/-SD] age 57 +/- 12 years, 302 men) were followed-up for 44 +/- 11 months. Outcome was related to the exercise and echocardiographic findings, and the incremental prognostic benefit of exercise echocardiography was compared with that of standard exercise testing.
Cardiac events occurred in 81 patients (17%), including 33 (7%) with spontaneous events (cardiac death, myocardial infarction and unstable angina) and 48 with late revascularizations due to progressive symptoms. In a multivariate Cox proportional hazards model, the likelihood of any cardiac event was increased in the presence of ischemia (relative risk [RR] 5.06, 95% confidence interval [CI] 3.09 to 8.29, p < 0.001) and lessened by more maximal stress, measured as percent age-predicted maximal heart rate (RR per 5% increment 0.84, 95% CI 0.77 to 0.92, p < 0.001). Spontaneous events were more strongly predicted by ischemia (RR 8.20, 95% CI 3.41 to 19.71, p < 0.001) and percent age-predicted maximal heart rate (RR per 5% increment 0.78, 95% CI 0.67 to 0.91, p < 0.001). An interactive logistic regression model showed that the addition of echocardiographic to exercise and clinical data offered incremental predictive value.
The presence of ischemia on the exercise echocardiogram can predict whether patients will experience an event. This relation is independent of, and incremental to, clinical and exercise data.
本研究前瞻性地比较了运动超声心动图与运动试验在一大群患者中的增量预后获益情况。
运动超声心动图被广泛认为是一种诊断工具，但该检查所提供的、超出临床和负荷试验评估的预后信息尚不明确。
对连续500例接受运动超声心动图检查的患者的临床、运动及超声心动图变量进行研究。排除在负荷试验后3个月内行血运重建术的患者（n = 16，3%）及失访患者（n = 21，4%）后，其余463例患者（平均年龄[±标准差]57±12岁，男性302例）随访44±11个月。结局与运动及超声心动图检查结果相关，并比较运动超声心动图与标准运动试验的增量预后获益。
81例患者（17%）发生心脏事件，包括33例（7%）自发事件（心源性死亡、心肌梗死和不稳定型心绞痛）和48例因症状进展而行晚期血运重建术的患者。在多变量Cox比例风险模型中，存在心肌缺血时发生任何心脏事件的可能性增加（相对风险[RR]5.06，95%置信区间[CI]3.09至8.29，p < 0.001），而以预测最大心率百分比衡量的更大运动负荷可降低该可能性（每增加5%的RR为0.84，95%CI 0.77至0.92，p < 0.001）。心肌缺血（RR 8.20，95%CI 3.41至19.71，p < 0.001）和预测最大心率百分比（每增加5%的RR为0.78，95%CI 0.67至0.91，p < 0.001）对自发事件的预测作用更强。交互逻辑回归模型显示，将超声心动图数据加入运动及临床数据可提供增量预测价值。
运动超声心动图显示存在心肌缺血可预测患者是否会发生事件。这种关系独立于临床和运动数据，且为其补充信息。
