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Khan JN, Griffiths T, Kanagala P, Kwok CS, Sandhu K, Cabezon S, Baig S, Naneishvili T, Kay Lee VC, Pasricha A, Robins E, Fatima T, Mihai A, Rai K, Booth S, Lee D, Bennett S, Butler R, Duckett S, Heatlie G. Accuracy and Prognostic Value of Physiologist-Led Stress Echocardiography for Coronary Disease. Heart Lung Circ 2020; 30:721-729. [PMID: 33191138 DOI: 10.1016/j.hlc.2020.09.933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 08/24/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND We demonstrated that physiologist-led stress echocardiography (PLSE) is feasible for coronary artery disease (CAD) assessment. We sought to extend our work by assessing its accuracy and prognostic value. METHODS Retrospective study of 898 subjects undergoing PLSE (n=393) or cardiologist-led stress echocardiography (CLSE) (n=505) for CAD assessment using exercise or dobutamine. For accuracy assessment, the primary outcome was the ability of stress echocardiography to identify significant CAD on invasive coronary angiography (ICA). Incidence of 24-month non-fatal MI, total and cardiac mortality, revascularisation and combined major adverse cardiac events (MACE) were assessed. RESULTS Demographics, comorbidities, CAD predictors, CAD pre-test probability and cardiac medications were matched between the PLSE and CLSE groups. PLSE had high sensitivity, specificity, positive and negative predictive value and accuracy (85%, 74%, 69%, 88%, 78% respectively). PLSE accuracy measures were similar and non-inferior to CLSE. There was a similar incidence of individual and combined outcomes in PLSE and CLSE subjects. Negative stress echocardiography conferred a comparably low incidence of non-fatal MI (PLSE 1.4% vs. CLSE 0.9%, p=0.464), cardiac mortality (0.6% vs. 0.0%, p=0.277) and MACE (6.8% vs. 3.1%, p=0.404). CONCLUSION This is the first study of the accuracy compared with gold standard of ICA, and prognostic value of PLSE CAD assessment. PLSE demonstrates high and non-inferior accuracy compared with CLSE for CAD assessment. Negative PLSE and CLSE confer a similarly very low incidence of cardiac outcomes, confirming for the first time the important prognostic value of PLSE.
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Affiliation(s)
- Jamal Nasir Khan
- Department of Cardiology, University Hospital of Coventry & Warwickshire, Coventry, England, UK; University of Warwick, Coventry, England, UK.
| | - Timothy Griffiths
- Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, England, UK
| | - Prathap Kanagala
- Department of Cardiology, Aintree Hospital, Liverpool, England, UK
| | - Chun Shing Kwok
- Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, England, UK
| | - Kully Sandhu
- Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, England, UK
| | - Sinead Cabezon
- Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, England, UK
| | - Shanat Baig
- Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, England, UK
| | - Tamara Naneishvili
- Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, England, UK
| | - Vetton Chee Kay Lee
- Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, England, UK
| | - Arron Pasricha
- Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, England, UK
| | - Emily Robins
- Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, England, UK
| | - Tamseel Fatima
- Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, England, UK
| | - Andreea Mihai
- Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, England, UK
| | - Kam Rai
- Department of Cardiology, University Hospital of Coventry & Warwickshire, Coventry, England, UK
| | - Samantha Booth
- Department of Cardiology, University Hospital of Coventry & Warwickshire, Coventry, England, UK
| | - Doug Lee
- Department of Cardiology, University Hospital of Coventry & Warwickshire, Coventry, England, UK
| | - Sadie Bennett
- Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, England, UK
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Caiazzo E, Morello S, Carnuccio R, Ialenti A, Cicala C. The Ecto-5'-Nucleotidase/CD73 Inhibitor, α,β-Methylene Adenosine 5'-Diphosphate, Exacerbates Carrageenan-Induced Pleurisy in Rat. Front Pharmacol 2019; 10:775. [PMID: 31354490 PMCID: PMC6637294 DOI: 10.3389/fphar.2019.00775] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/17/2019] [Indexed: 11/17/2022] Open
Abstract
The ecto-5’-nucleotidase (ecto-5’NT/CD73) represents a crucial enzyme for endogenous adenosine generation. Several findings have shown that CD73 plays an important role in regulating vascular permeability and immune cell function. Adenosine 5’-(α,β-methylene)diphosphate (APCP) is a CD73 inhibitor, widely used as pharmacological tool to investigate the role of CD73/adenosine pathway in several in vitro and in vivo models, although it has been also shown to inhibit other ectoenzymes involved in adenosinergic pathway. Here, we evaluated the effect of APCP in the development of inflammation in carrageenan-induced pleurisy model. We found that treatment with APCP (400 µg/rat) significantly increased cell accumulation, exudate formation, and pro-inflammatory cytokine content into the pleural cavity in the acute phase (4 h) of inflammation, with no differences in the sub-acute phase (72 h) except for the regulation of monocyte chemotactic protein-1 levels. In addition, cells collected by pleural lavage fluids of APCP-treated rats, 4 h following carrageenan injection, showed increased ability to migrate in vitro, both in presence and in absence of N-formyl-L-methionyl-L-leucyl-L-phenylalanine as chemotactic stimulus, compared to cells obtained by control rats. Our results demonstrate that APCP exacerbates the early phase of carrageenan-induced pleurisy by controlling pleural effusion and polymorphonuclear migration in vivo and ex vivo. This effect is likely dependent upon CD73 inhibition, although an inhibitory effect of other ectoenzymes cannot be ruled out.
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Affiliation(s)
- Elisabetta Caiazzo
- Department of Pharmacy, School of Medicine, University of Naples Federico II, Via Domenico Montesano 49, Naples, Italy
| | - Silvana Morello
- Department of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, Fisciano, SA, Italy
| | - Rosa Carnuccio
- Department of Pharmacy, School of Medicine, University of Naples Federico II, Via Domenico Montesano 49, Naples, Italy
| | - Armando Ialenti
- Department of Pharmacy, School of Medicine, University of Naples Federico II, Via Domenico Montesano 49, Naples, Italy
| | - Carla Cicala
- Department of Pharmacy, School of Medicine, University of Naples Federico II, Via Domenico Montesano 49, Naples, Italy
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Choi JO, Chang SA, Park SJ, Lee SC, Park SW. Improved detection of ischemic heart disease by combining high-frequency electrocardiogram analysis with exercise stress echocardiography. Korean Circ J 2013; 43:674-80. [PMID: 24255651 PMCID: PMC3831013 DOI: 10.4070/kcj.2013.43.10.674] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 08/30/2013] [Accepted: 09/03/2013] [Indexed: 11/12/2022] Open
Abstract
Background and Objectives Because the exercise treadmill test (ETT) based on ST-segment analysis is limited due to low sensitivity and specificity, there has been an interest in the additional analysis of high-frequency components of QRS (HFQRS) for the detection of coronary artery disease (CAD). We sought to evaluate the feasibility and clinical usefulness of HFQRS analysis during exercise stress echocardiography (ESE). Subjects and Methods We evaluated 175 patients (age 57±9,118 men) who performed ESE and either coronary computed tomographic angiography or coronary angiography. ETT was performed using the HyperQ stress system for both conventional ST-segment analysis and HFQRS intensity analysis. Results Thirty-two patients (31%) had significant CAD. The sensitivity and specificity of HFQRS analysis were 68.8% and 74.8%, respectively. The combined model, including HFQRS analysis and ESE, provided the best diagnostic accuracy, with the area under the receiver-operating characteristics curve (AUC) of 0.948 {95% confidence interval (CI)=0.913-0.984} compared with ST-segment analysis (AUC 0.679, 95% CI=0.592-0.766). Conclusion HFQRS analysis during ESE is feasible and may provide additional diagnostic information for the detection of significant CAD.
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Affiliation(s)
- Jin-Oh Choi
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Banerjee A, Newman DR, Van den Bruel A, Heneghan C. Diagnostic accuracy of exercise stress testing for coronary artery disease: a systematic review and meta-analysis of prospective studies. Int J Clin Pract 2012; 66:477-92. [PMID: 22512607 DOI: 10.1111/j.1742-1241.2012.02900.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Exercise stress testing offers a non-invasive, less expensive way of risk stratification prior to coronary angiography, and a negative stress test may actually avoid angiography. However, previous meta-analyses have not included all exercise test modalities, or patients without known Coronary artery disease (CAD). METHODS AND RESULTS We systematically reviewed the literature to determine the diagnostic accuracy of exercise stress testing for CAD on angiography. MEDLINE (January 1966 to November 2009), MEDION (1966 to July 2009), CENTRAL (1966 to July 2009) and EMBASE (1980-2009) databases were searched for English language articles on diagnostic accuracy of exercise stress testing. We included prospective studies comparing exercise stress testing with a reference standard of coronary angiography in patients without known CAD. From 6,055 records, we included 34 studies with 3,352 participants. Overall, we found published studies regarding five different exercise testing modalities: treadmill ECG, treadmill echo, bicycle ECG, bicycle echo and myocardial perfusion imaging. The prevalence of CAD ranged from 12% to 83%. Positive and negative likelihood ratios of stress testing increased in low prevalence settings. Treadmill echo testing (LR+ = 7.94) performed better than treadmill ECG testing (LR+ = 3.57) for ruling in CAD and ruling out CAD (echo LR- = 0.19 vs. ECG LR- = 0.38). Bicycle echo testing (LR+ = 11.34) performed better than treadmill echo testing (LR+ = 7.94), which outperformed both treadmill ECG and bicycle ECG. A positive exercise test is more helpful in younger patients (LR+ = 4.74) than in older patients (LR+ = 2.8). CONCLUSIONS The diagnostic accuracy of exercise testing varies, depending upon the age, gender and clinical characteristics of the patient, prevalence of CAD and modality of test used. Exercise testing, whether by echocardiography or ECG, is more useful at excluding CAD than confirming it. Clinicians have concentrated on individualising the treatment of CAD, but there is great scope for individualising the diagnosis of CAD using exercise testing.
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Affiliation(s)
- A Banerjee
- Centre for Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
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Squeri A, Gaibazzi N, Reverberi C, Caracciolo MM, Ardissino D, Gherli T. Ejection fraction change and coronary artery disease severity: a vasodilator contrast stress-echocardiography study. J Am Soc Echocardiogr 2012; 25:454-9. [PMID: 22243999 DOI: 10.1016/j.echo.2011.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND An important goal of noninvasive stress testing is the identification of patients with left main coronary artery or three-vessel disease, because coronary artery disease extension and severity are major prognostic factors in ischemic heart disease. Wall motion abnormalities during vasodilator stress echocardiography become apparent in more than one coronary territory only in a small number of patients with multivessel disease. The aim of this study was to assess the value of change in left ventricular ejection fraction change (ΔLVEF) to identify patients with multivessel obstructive coronary artery disease during dipyridamole stress echocardiography. METHODS All dipyridamole stress echocardiographic studies performed at the authors' institution from October 2007 through March 2010 were retrospectively reviewed, and 150 patients who underwent coronary angiography within the next 60 days were selected. Left ventricular end-diastolic volume and end-systolic volume were measured at baseline and at the end of high-dose dipyridamole; ΔLVEF was calculated as stress ejection fraction minus rest ejection fraction. Patients were divided into four groups (controls and patients with single-vessel, two-vessel, and three-vessel disease) on the basis of coronary angiographic results. RESULTS The mean LVEF increased significantly from rest to peak stress in all groups except the three-vessel disease group. Mean ΔLVEF was negative in patients with three-vessel or left main coronary artery disease (-2.8 ± 5.1%) and significantly lower compared with all other angiographic groups (10.2 ± 5.1% and 6.2 ± 4.1%, respectively, for single-vessel and two-vessel disease). The negative value of ΔLVEF for three-vessel disease was due mainly to increased end-systolic volume at peak stress. Receiver operating characteristic curves demonstrated excellent accuracy of ΔLVEF compared with change in wall motion score index in identifying patients with multivessel disease, with areas under the curves of 0.96 and 0.62, respectively. CONCLUSIONS ΔLVEF is significantly lower in patients with severe coronary artery disease compared with those with single-vessel or two-vessel disease; reduced ΔLVEF identifies high-risk patients, who are likely to benefit from a more aggressive therapeutic strategy.
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Affiliation(s)
- Angelo Squeri
- U.O. Cardiologia, Dipartimento Cardio-Nefro-Polmonare, Azienda Ospedaliero, Universitaria di Parma, Via Gramsci 14, Parma, Italy.
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Forte EH, Rousse MG, Lowenstein JA. Target heart rate to determine the normal value of coronary flow reserve during dobutamine stress echocardiography. Cardiovasc Ultrasound 2011; 9:10. [PMID: 21457582 PMCID: PMC3080796 DOI: 10.1186/1476-7120-9-10] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 04/04/2011] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The determination of coronary flow reserve (CFR) is an essential concept at the moment of decision-making in ischemic heart disease. There are several direct and indirect tests to evaluate this parameter. In this sense, dobutamine stress echocardiography is one of the pharmacological method most commonly used worldwide. It has been previously demonstrated that CFR can be determined by this technique. Despite our wide experience with dobutamine stress echocardiography, we ignored the necessary heart rate to consider sufficient the test for the analysis of CFR. For this reason, our main goal was to determine the velocity of coronary flow in each stage of dobutamine stress echocardiography and the heart rate value necessary to double the baseline values of coronary flow velocity in the territory of the left anterior descending (LAD) coronary artery. METHODS A total of 33 consecutive patients were analyzed. The patients included had low risk for coronary artery disease. All the participants underwent dobutamine stress echocardiography and coronary artery flow velocity was evaluated in the distal segment of LAD coronary artery using transthoracic color-Doppler echocardiography. RESULTS The feasibility of determining CFR in the territory of the LAD during dobutamine stress echocardiography was high: 31/33 patients (94%). Mean CFR was 2.67 at de end of dobutamine test.There was an excellent concordance between delta HR (difference between baseline HR and maximum HR) and the increase in the CFR (correlation coefficient 0.84). In this sense, we found that when HR increased by 50 beats, CFR was ≥ 2 (CI 93-99.2%). In addition, 96.4% of patients reached a CFR ≥ 2 (IC 91.1 - 99%) at 75% of their predicted maximum heart rate. CONCLUSIONS We found that the feasibility of dobutamine stress echocardiography to determine CFR in the territory of the LAD coronary artery was high. In this study, it was necessary to achieve a difference of 50 bpm from baseline HR or at least 75% of the maximum predicted heart rate to consider sufficient the test for the analysis of CFR.
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Diagnostic accuracy meta-analysis: A review of the basic principles of interpretation and application. Int J Cardiol 2010; 140:138-44. [DOI: 10.1016/j.ijcard.2009.05.063] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Revised: 05/08/2009] [Accepted: 05/30/2009] [Indexed: 11/17/2022]
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Geleijnse ML, Krenning BJ, van Dalen BM, Nemes A, Soliman OII, Bosch JG, Galema TW, ten Cate FJ, Boersma E. Factors affecting sensitivity and specificity of diagnostic testing: dobutamine stress echocardiography. J Am Soc Echocardiogr 2009; 22:1199-208. [PMID: 19766453 DOI: 10.1016/j.echo.2009.07.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2008] [Indexed: 12/15/2022]
Abstract
BACKGROUND Clinical characteristics of patients, angiographic referral bias, and several technical factors may all affect the reported diagnostic accuracy of tests. The aim of this study was to assess their influence on the diagnostic accuracy of dobutamine stress echocardiography (DSE). METHODS The medical literature from 1991 to 2006 was searched for diagnostic studies using DSE and meta-analysis was applied to the 62 studies thus retrieved, including 6881 patients. These studies were analyzed for patient characteristics, angiographic referral bias, and several technical factors. RESULTS The sensitivity of DSE was significantly related to the inclusion of patients with prior myocardial infarctions (0.834 vs 0.740, P < .01) and defining the results of DSE as already positive in case of resting wall motion abnormalities rather than obligatory myocardial ischemia (0.786 vs 0.864, P < .01). Specificity tended to be lower when patients with resting wall motion abnormalities were included in a study (0.812 vs 0.877, P < .10). The presence of referral bias adversely affected the specificity of DSE (0.771 vs 0.842, P < .01). CONCLUSION This analysis suggests that the reported sensitivity of DSE is likely higher and the specificity lower than expected in routine clinical practice because of the inappropriate inclusion of patients with prior myocardial infarctions, the definition of positive results on DSE, and the negative influence of referral bias. However, in the patient subset that will be sent to coronary angiography, the opposite results can be expected.
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Sicari R, Nihoyannopoulos P, Evangelista A, Kasprzak J, Lancellotti P, Poldermans D, Voigt JU, Zamorano JL. Stress Echocardiography Expert Consensus Statement--Executive Summary: European Association of Echocardiography (EAE) (a registered branch of the ESC). Eur Heart J 2008; 30:278-89. [PMID: 19001473 DOI: 10.1093/eurheartj/ehn492] [Citation(s) in RCA: 233] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Rosa Sicari
- Institute of Clinical Physiology, Pisa, Italy.
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Picano E, Molinaro S, Pasanisi E. The diagnostic accuracy of pharmacological stress echocardiography for the assessment of coronary artery disease: a meta-analysis. Cardiovasc Ultrasound 2008; 6:30. [PMID: 18565214 PMCID: PMC2443362 DOI: 10.1186/1476-7120-6-30] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Accepted: 06/19/2008] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Recent American Heart Association/American College of Cardiology guidelines state that "dobutamine stress echo has substantially higher sensitivity than vasodilator stress echo for detection of coronary artery stenosis" while the European Society of Cardiology guidelines and the European Association of Echocardiography recommendations conclude that "the two tests have very similar applications". Who is right? AIM To evaluate the diagnostic accuracy of dobutamine versus dipyridamole stress echocardiography through an evidence-based approach. METHODS From PubMed search, we identified all papers with coronary angiographic verification and head-to-head comparison of dobutamine stress echo (40 mcg/kg/min +/- atropine) versus dipyridamole stress echo performed with state-of-the art protocols (either 0.84 mg/kg in 10' plus atropine, or 0.84 mg/kg in 6' without atropine). A total of 5 papers have been found. Pooled weight meta-analysis was performed. RESULTS the 5 analyzed papers recruited 435 patients, 299 with and 136 without angiographically assessed coronary artery disease (quantitatively assessed stenosis > 50%). Dipyridamole and dobutamine showed similar accuracy (87%, 95% confidence intervals, CI, 83-90, vs. 84%, CI, 80-88, p = 0.48), sensitivity (85%, CI 80-89, vs. 86%, CI 78-91, p = 0.81) and specificity (89%, CI 82-94 vs. 86%, CI 75-89, p = 0.15). CONCLUSION When state-of-the art protocols are considered, dipyridamole and dobutamine stress echo have similar accuracy, specificity and - most importantly - sensitivity for detection of CAD. European recommendations concluding that "dobutamine and vasodilators (at appropriately high doses) are equally potent ischemic stressors for inducing wall motion abnormalities in presence of a critical coronary artery stenosis" are evidence-based.
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Ecocardiograma de estrés. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2008. [DOI: 10.1016/s0120-3347(08)62004-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Rossi A, Moccetti T, Faletra F, Cattaneo P, Rossi M, Pasotti E, Fantoni C, Anzà C, Baravelli M. Dipyridamole stress echocardiography stratifies outcomes of asymptomatic patients with recent myocardial revascularization. Int J Cardiovasc Imaging 2007; 24:495-502. [DOI: 10.1007/s10554-007-9289-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Accepted: 12/10/2007] [Indexed: 11/28/2022]
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Baroncini LAV. Short-term Risk Stratification with Accelerated High-dose Dipyridamole Stress Echocardiography: Follow-up into 301 Consecutive Outpatients. J Am Soc Echocardiogr 2007; 20:253-6. [PMID: 17336750 DOI: 10.1016/j.echo.2006.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2006] [Indexed: 10/23/2022]
Abstract
AIM This study aimed to assess the short-term predictive value of a pharmacologic stress echocardiography test performed with accelerated high-dose dipyridamole (0.84 mg/kg over 6 minutes). METHODS In all, 301 patients (161 men, mean age 61.41 +/- 11.62 years) were scheduled for accelerated high-dose dipyridamole stress test. A total of 22 tests were interrupted prematurely because of side effects (overall feasibility 92.7%). The patients were followed up for nonfatal myocardial infarction, unstable angina, myocardial revascularization, and sudden death at first and third months and each 6 months (maximum 18 months). RESULTS A positive echocardiographic response was found in 25 patients. Six patients with negative stress test experienced events. Eight patients with positive stress test went to coronary revascularization procedure. Negative predictive value was 97.8%, positive predictive value was 32%, sensitivity was 57%, and specificity was 94%. CONCLUSIONS Risk stratification with accelerated high-dose dipyridamole stress echocardiography is effective. A negative test predicts favorable short-term cardiovascular prognosis.
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Affiliation(s)
- Liz Andréa V Baroncini
- Department of Surgery, Faculdade de Medicina, Federal do Paraná University, Curitiba, Brazil.
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