Value of reserve pulse pressure in improving the risk stratification of patients with normal myocardial perfusion imaging.
Value of reserve pulse pressure in improving the risk stratification of patients with normal myocardial perfusion imaging.
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DOI：
10.1093/eurheartj/eht102
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发表时间：
2013-07
影响因子：
39.3
通讯作者：
Deepak Thomas;M. Al-Mallah;Usha Govindarajulu;D. Forman;S. Mora;M. D. Di Carli;S. Dorbala
中科院分区：
文献类型：
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作者：
Deepak Thomas;M. Al-Mallah;Usha Govindarajulu;D. Forman;S. Mora;M. D. Di Carli;S. Dorbala
目的评价储备脉压（reserve-PP：运动- pp减去休息- pp）对疑似冠状动脉疾病（CAD）但运动心肌灌注成像（MPI）正常的患者标准危险因素的增量预后价值。方法和结果：我们研究了4269例连续的无CAD症状的患者，这些患者被推荐进行MPI运动，但MPI结果正常（平均年龄58±12岁，56%为女性，84%被推荐评估胸痛或呼吸困难，95%有CAD的中等前检可能性）。在5.1±1.4年的随访中，有202例死亡。1894例（44%）患者的储备-PP异常（休息时PP升高<44 mmHg）。与正常储备- pp患者相比，异常储备- pp患者的死亡风险更高[风险比（HR）： 2.47, 95% CI, 1.8-3.3]。在调整了年龄、性别、射血分数、药物、心率恢复、杜克跑步机评分（DTS）和休息- pp的多变量模型中，储备- pp每降低10 mmHg，风险调整死亡率增加20.6%（调整HR 0.83, 95% CI 0.76-0.91）。与不含这些参数的模型相比，纳入储备- pp的模型对风险进行了显著重分类（净重分类指数14.3%,P = 0.0007；综合区分指数0.69,P = 0.01）。结论在没有CAD病史和MPI正常的患者中，异常储备- pp识别并重新分类了与已知危险因素和DTS无关的死亡高危人群。
AIMS To evaluate the incremental prognostic value of reserve-pulse pressure (reserve-PP: exercise-PP minus rest-PP) to standard risk factors among patients with suspected coronary artery disease (CAD) but normal exercise myocardial perfusion imaging (MPI). METHODS AND RESULTS We studied 4269 consecutive symptomatic patients without known CAD who were referred for exercise MPI but had normal MPI results (mean age 58 ± 12 years, 56% females, 84% referred for evaluation of chest pain or dyspnoea, 95% with intermediate pretest likelihood of CAD). There were 202 deaths over 5.1 ± 1.4 years of follow-up. Reserve-PP was abnormal (<44 mmHg increase in PP from rest) in 1894 patients (44%). Patients with an abnormal reserve-PP had a higher risk of death compared with patients with normal reserve-PP [hazard ratio (HR): 2.47, 95% CI, 1.8-3.3]. In multivariable models adjusting for age, sex, ejection fraction, medications, heart rate recovery, Duke treadmill score (DTS), and rest-PP, each 10 mmHg lower reserve-PP was associated with a 20.6% increase in risk-adjusted mortality (adjusted HR 0.83, 95% CI 0.76-0.91). Models incorporating reserve-PP significantly reclassified risk compared with models without these parameters (net reclassification index 14.3%, P = 0.0007; integrated discrimination index 0.69, P = 0.01). CONCLUSION In patients without a history of CAD and a normal MPI, an abnormal reserve-PP identified and reclassified those at higher risk of death independent of known risk factors and DTS.