Prognostic value of negative transesophageal dobutamine stress echocardiography in men at high risk for coronary artery disease

被引:6
作者
Kamalesh, M
Sawada, S
Humphreys, A
Tawam, M
Blessent, R
Winter, L
机构
[1] Univ Illinois, Coll Med, Vet Affairs Med Ctr, Danville, IL 61832 USA
[2] Krannert Inst Cardiol, Indianapolis, IN USA
关键词
D O I
10.1016/S0002-9149(99)00602-5
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Recently published reviews have called into question the sensitvity of transthoracic stress echocardiography to predict cardiac events, especially when the test is negative, compared with myocardial perfusion imaging studies. To our knowledge there are a lack of data assessing the prognostic value of transesophageal echocardiography-dobutamine stress echocardiography (TEE-DSE) in predicting cardiac events. Because TEE-DSE has been reported to be highly accurate for detecting ischemia in patients with suspected coronary artery disease, we tested the hypothesis that a negative TEE-DSE can identify a low-risk group in a population with a high likelihood of coronary artery disease. Between October 1996 and December 1997, 46 high-risk patients with negative TEE-DSE were identified. Annualized pretest risk for all cardiac events using the Framingham model was 4% based on risk factors. Mean age was 64 years. Mean follow-up time was 16.2 months. There were no cardiac deaths. There were 6 soft and 1 hard cardiac event. The annualized combined ischemic cardiac event rate was 3.8%, and for hard cardiac events it was 1.1%. By Kaplan-Meier analysis, 97% of the population remained free of any ischemic event at the end of 1 year and 93% were free at 22 months. We conclude that optimal image quality and enhanced endocardial definition for assessing wall motion changes with TEE translates into better prognostication and approaches that of myocardial perfusion imaging for negative studies. Advances in ultrasound medicine such as contrast enhancement of myocardial definition, which improve diagnostic accuracy of DSE, should translate into better prognostication. (C) 2000 by Excerpta Medica, Inc.
引用
收藏
页码:41 / 44
页数:4
相关论文
共 20 条
[1]   DOBUTAMINE STRESS ECHOCARDIOGRAPHY - SENSITIVITY, SPECIFICITY, AND PREDICTIVE VALUE FOR FUTURE CARDIAC EVENTS [J].
AFRIDI, I ;
QUINONES, MA ;
ZOGHBI, WA ;
CHEIRIF, J .
AMERICAN HEART JOURNAL, 1994, 127 (06) :1510-1515
[2]   Cardiac outcomes in coronary patients with submaximum dobutamine stress echocardiography [J].
Ballal, RS ;
Secknus, MA ;
Mehta, R ;
Kapadia, S ;
Lauer, MS ;
Marwick, TH .
AMERICAN JOURNAL OF CARDIOLOGY, 1997, 80 (06) :725-729
[3]  
Beller GA, 1998, J AM COLL CARDIOL, V31, P1286
[5]  
Brown KA, 1998, AM J CARDIOL, V81, P1050
[6]  
Carlos ME, 1997, CIRCULATION, V95, P1402
[7]  
Chuah SC, 1998, CIRCULATION, V97, P1474
[8]   TRANSESOPHAGEAL DOBUTAMINE STRESS ECHOCARDIOGRAPHY IN THE EVALUATION OF CORONARY-ARTERY DISEASE [J].
FROHWEIN, S ;
KLEIN, JL ;
LANE, A ;
TAYLOR, WR .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1995, 25 (04) :823-829
[9]   Methodology, feasibility, safety and diagnostic accuracy of dobutamine stress echocardiography [J].
Geleijnse, ML ;
Fioretti, PM ;
Roelandt, JRTC .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1997, 30 (03) :595-606
[10]   Prognostic value of dobutamine echocardiography early after uncomplicated acute myocardial infarction: A comparison with exercise electrocardiography [J].
Greco, CA ;
Salustri, A ;
Seccareccia, F ;
Ciavatti, M ;
Biferali, F ;
Valtorta, C ;
Guzzardi, G ;
Falcone, M ;
Palamara, A .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1997, 29 (02) :261-267