Additional prognostic value of physical examination, exercise testing, and arterial ultrasonography for coronary risk assessment in primary prevention

被引:29
作者
Cournot, Maxime [1 ,2 ]
Taraszkiewicz, Dorota [3 ]
Cambou, Jean-Pierre [4 ]
Galinier, Michel [3 ]
Boccalon, Henri [4 ]
Hanaire-Broutin, Helene [5 ]
Chamontin, Bernard [6 ]
Carrie, Didier [3 ]
Ferrieres, Jean [1 ,3 ]
机构
[1] INSERM, U558, F-31073 Toulouse, France
[2] Ctr Hosp Val dAriege, Dept Prevent Med, Foix, France
[3] CHU Rangueil, Prevent Cardiol Unit, F-31054 Toulouse, France
[4] CHU Rangueil, Dept Vasc Med, F-31054 Toulouse, France
[5] CHU Rangueil, Dept Diabetol, F-31054 Toulouse, France
[6] CHU Rangueil, Dept Internal Med & Hypertens, F-31054 Toulouse, France
关键词
HEART-DISEASE; MYOCARDIAL-INFARCTION; CARDIOVASCULAR-DISEASE; PREDICTIVE-VALUE; EVENTS; MEN; ELECTROCARDIOGRAM; ATHEROSCLEROSIS; ASSOCIATION; FRAMINGHAM;
D O I
10.1016/j.ahj.2009.08.017
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background The choice of noninvasive tests used in primary prevention of cardiovascular diseases must be based on medical evidence. The aim of this study was to assess the additional prognostic value, over conventional risk factors, of physical examination, exercise testing, and arterial ultrasonography, in predicting a first coronary event. Methods A prospective cohort study was conducted between 1996 and 2004 (n = 2,709), with follow-up in 2006 (response rate 96.6%). Participants had no history or symptoms of cardiovascular disease and had a standardized physical examination, a cardiac exercise testing, and carotid and femoral ultrasonography at baseline. Incident cases of definite coronary events were recorded during follow-up. Results Over the Framingham risk score, femoral bruit, positive exercise test, intima-media thickness >0.63 mm, and a femoral plaque provided significant additional information to the prediction model. The addition of the exercise test to the traditional risk factors, then the intima-media thickness and lastly the presence of femoral plaques, produces incremental increases in the area under the receiver operating characteristic curve (0.73-0.78, P = .02) and about a 50% increase in the positive predictive value (15.8%-31.4%), with no effect on the negative predictive value (96.4%-96.9%). Conclusion Physical examination, exercise testing, and arterial ultrasonography provide incremental information on the risk of coronary event in asymptomatic adults. Exercise testing and femoral ultrasonography also improve the accuracy of the risk stratification. (Am Heart J 2009; 158:845-51.)
引用
收藏
页码:845 / 851
页数:7
相关论文
共 31 条
[1]   NEW LOOK AT STATISTICAL-MODEL IDENTIFICATION [J].
AKAIKE, H .
IEEE TRANSACTIONS ON AUTOMATIC CONTROL, 1974, AC19 (06) :716-723
[2]   AN UPDATED CORONARY RISK PROFILE - A STATEMENT FOR HEALTH-PROFESSIONALS [J].
ANDERSON, KM ;
WILSON, PWF ;
ODELL, PM ;
KANNEL, WB .
CIRCULATION, 1991, 83 (01) :356-362
[3]   Carotid and femoral ultrasound morphology screening and cardiovascular events in low risk subjects: a 10-year follow-up study (the CAFES-CAVE study) [J].
Belcaro, G ;
Nicolaides, AN ;
Ramaswami, G ;
Cesarone, MR ;
De Sanctis, M ;
Incandela, L ;
Ferrari, P ;
Geroulakos, G ;
Barsotti, A ;
Griffin, M ;
Dhanjil, S ;
Sabetai, M ;
Bucci, M ;
Martines, G .
ATHEROSCLEROSIS, 2001, 156 (02) :379-387
[4]   Incremental predictive value of carotid ultrasonography in the assessment of coronary risk in a cohort of asymptomatic type 2 diabetic subjects [J].
Bernard, S ;
Sérusclat, A ;
Targe, F ;
Charrière, S ;
Roth, O ;
Beaune, J ;
Berthezène, F ;
Moulin, P .
DIABETES CARE, 2005, 28 (05) :1158-1162
[5]   ENHANCED RISK ASSESSMENT FOR PRIMARY CORONARY HEART-DISEASE EVENTS BY MAXIMAL EXERCISE TESTING - 10 YEARS EXPERIENCE OF SEATTLE HEART WATCH [J].
BRUCE, RA ;
HOSSACK, KF ;
DEROUEN, TA ;
HOFER, V .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1983, 2 (03) :565-573
[6]  
Chambless LE, 1997, AM J EPIDEMIOL, V146, P483, DOI 10.1093/oxfordjournals.aje.a009302
[7]   Time to foster a rational approach to preventing cardiovascular morbid events [J].
Cohn, Jay N. ;
Duprez, Daniel A. .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2008, 52 (05) :327-329
[8]   Five-year incidence of angina pectoris and other forms of coronary heart disease in healthy men aged 50-59 in France and Northern Ireland:: the Prospective Epidemiological Study of Myocardial Infarction (PRIME) Study [J].
Ducimetière, P ;
Ruidavets, JB ;
Montaye, M ;
Haas, B ;
Varnell, J .
INTERNATIONAL JOURNAL OF EPIDEMIOLOGY, 2001, 30 (05) :1057-1062
[9]   Are the Framingham and PROCAM coronary heart disease risk functions applicable to different European populations?: The PRIME Study [J].
Empana, JP ;
Ducimetière, P ;
Arveiler, D ;
Ferrières, J ;
Evans, A ;
Ruidavets, JB ;
Haas, B ;
Yarnell, J ;
Bingham, A ;
Amouyel, P ;
Dallongeville, J .
EUROPEAN HEART JOURNAL, 2003, 24 (21) :1903-1911
[10]   PREDICTIVE VALUE OF THE EXERCISE TOLERANCE-TEST FOR MORTALITY IN NORTH-AMERICAN MEN - THE LIPID RESEARCH CLINICS MORTALITY FOLLOW-UP-STUDY [J].
GORDON, DJ ;
EKELUND, LG ;
KARON, JM ;
PROBSTFIELD, JL ;
RUBENSTEIN, C ;
SHEFFIELD, LT ;
WEISSFELD, L .
CIRCULATION, 1986, 74 (02) :252-261