Outcomes after normal dobutamine stress echocardiography and predictors of adverse events: long-term follow-up of 3014 patients
Outcomes after normal dobutamine stress echocardiography and predictors of adverse events: long-term follow-up of 3014 patients
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DOI：
10.1093/eurheartj/ehl393
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发表时间：
2006-12-01
影响因子：
39.3
通讯作者：
Pellikka, Patricia A.
中科院分区：
文献类型：
--
作者：
Chaowalit, Nithima;McCully, Robert B.;Pellikka, Patricia A.
目的正常运动超声心动图预测良好的预后。多巴酚丁胺负荷超声心动图（DSE）通常保留给合并症的患者，这些患者无法进行运动试验。我们评估正常DSE.Methods和结果后的不良事件的预测因素，我们研究了3014例（1200男性，68 +/- 12岁）与正常DSE，定义为没有室壁运动异常在休息或压力。在中位随访6.3年期间，分别有920例（31%）和231例（7.7%）患者发生全因死亡和心脏事件（定义为心肌梗死和冠状动脉血运重建）。1年生存率和无心脏事件概率分别为95%和98%，5年为78%和93%，10年为56%和89%。年龄、糖尿病和未能达到85%年龄预测的最大心率是死亡率和心脏事件的独立预测因素。所有这三个特点的患者有13%的概率在第一年内的心脏事件和更高的风险在整个follow-up.Conclusion正常DSE后的预后不一定是良性的，但取决于病人和压力测试的特点。需要使用临床和压力数据进行仔细评估，以确定DSE正常的患者在长期随访期间不良结局风险增加。
Aims Normal exercise echocardiography predicts a good prognosis. Dobutamine stress echocardiography (DSE) is generally reserved for patients with comorbidities which preclude exercise testing. We evaluated predictors of adverse events after normal DSE.Methods and results We studied 3014 patients (1200 males, 68 +/- 12 years) with normal DSE, defined as the absence of wall motion abnormality at rest or with stress. During median follow-up of 6.3 years, all-cause mortality and cardiac events, defined as myocardial infarction and coronary revascularization, occurred in 920 (31%) and 231 (7.7%) patients, respectively. Survival and cardiac event-free probabilities were 95 and 98% at 1 year, 78 and 93% at 5 years, and 56 and 89% at 10 years, respectively. Age, diabetes mellitus, and failure to achieve 85% age-predicted maximal heart rate were independent predictors of mortality and cardiac events. Patients with all three of these characteristics had a 13% probability of cardiac events within the first year and higher risk throughout follow-up.Conclusion Prognosis after normal DSE is not necessarily benign, but depends on patient and stress test characteristics. Careful evaluation, using clinical and stress data, is required to identify patients with normal DSE who are at increased risk of adverse outcomes during long-term follow-up.