BackgroundStudies have demonstrated the diagnostic accuracy and prognostic value of physical
stress echocardiography in coronary artery disease. However, the prediction of
mortality and major cardiac events in patients with exercise test positive for
myocardial ischemia is limited.ObjectiveTo evaluate the effectiveness of physical stress echocardiography in the
prediction of mortality and major cardiac events in patients with exercise test
positive for myocardial ischemia.MethodsThis is a retrospective cohort in which 866 consecutive patients with exercise
test positive for myocardial ischemia, and who underwent physical stress
echocardiography were studied. Patients were divided into two groups: with
physical stress echocardiography negative (G1) or positive (G2) for myocardial
ischemia. The endpoints analyzed were all‑cause mortality and major cardiac
events, defined as cardiac death and non-fatal acute myocardial infarction.ResultsG2 comprised 205 patients (23.7%). During the mean 85.6 ± 15.0-month follow-up,
there were 26 deaths, of which six were cardiac deaths, and 25 non-fatal
myocardial infarction cases. The independent predictors of mortality were: age,
diabetes mellitus, and positive physical stress echocardiography (hazard ratio:
2.69; 95% confidence interval: 1.20 – 6.01; p = 0.016). The independent predictors
of major cardiac events were: age, previous coronary artery disease, positive
physical stress echocardiography (hazard ratio: 2.75; 95% confidence interval:
1.15 – 6.53; p = 0.022) and absence of a 10% increase in ejection fraction.
All-cause mortality and the incidence of major cardiac events were significantly
higher in G2 (p < 0. 001 and p = 0.001, respectively).ConclusionPhysical stress echocardiography provides additional prognostic information in
patients with exercise test positive for myocardial ischemia.
Relata-se o caso de uma paciente de 45 anos portadora de síndrome da imunodeficiência adquirida (SIDA), não aderente ao tratamento para tuberculose pulmonar, que evoluiu com hemoptise importante. Aos exames de imagem, evidenciavam-se cavernas pulmonares com presença, no interior destas, de estruturas de partes sólidas. Foram obtidos, no lavado broncoalveolar, Aspergillus sp. Devido às repetidas hemoptises, a paciente foi submetida à cirurgia. Porém, apresentou má evolução no pós-operatório e apresentou como desfecho o óbito.
Relata-se o caso de uma paciente de 45 anos portadora de síndrome da imunodeficiência adquirida (SIDA), não aderente ao tratamento para tuberculose pulmonar, que evoluiu com hemoptise importante. Aos exames de imagem, evidenciavam-se cavernas pulmonares com presença, no interior destas, de estruturas de partes sólidas. Foram obtidos, no lavado broncoalveolar, Aspergillus sp. Devido às repetidas hemoptises, a paciente foi submetida à cirurgia. Porém, apresentou má evolução no pós-operatório e apresentou como desfecho o óbito.
Relata-se o caso de uma paciente de 45 anos portadora de síndrome da imunodeficiência adquirida (SIDA), não aderente ao tratamento para tuberculose pulmonar, que evoluiu com hemoptise importante. Aos exames de imagem, evidenciavam-se cavernas pulmonares com presença, no interior destas, de estruturas de partes sólidas. Foram obtidos, no lavado broncoalveolar, Aspergillus sp. Devido às repetidas hemoptises, a paciente foi submetida à cirurgia. Porém, apresentou má evolução no pós-operatório e apresentou como desfecho o óbito.
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