Comparison of stress/rest myocardial perfusion tomography, dipyridamole and dobutamine stress echocardiography for the detection of coronary disease in hypertensive patients with chest pain and positive exercise test

Fragasso, Gabriele; Lu, Chunzeng; Dąbrowski, Paweł; Pagnotta, Paolo; Sheiban, Imad; Chierchia, Sergio

doi:10.1016/s0735-1097(99)00231-4

Cited by 120 publications

(63 citation statements)

References 24 publications

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“…The presence of hypertension may cloud the diagnosis of CAD because chest pain and dyspnea, as well as stress-induced ST-segment changes, may be due to hypertensive heart disease even in the absence of CAD. However, although stress echocardiography has been shown to improve the diagnosis of CAD in hypertensive patients, [1][2][3] its value in prognostic evaluation is unclear.…”

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confidence: 99%

Prediction of Outcomes in Hypertensive Patients With Suspected Coronary Disease

et al. 2002

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Abstract-Stress echocardiography has been shown to improve the diagnosis of coronary artery disease in the presence of hypertension, but its value in prognostic evaluation is unclear. We sought to determine whether stress echocardiography could be used to predict mortality in 2363 patients with hypertension, who were followed for up to 10 years (mean 4.0Ϯ1.8) for death and revascularization. Stress echocardiograms were normal in 1483 patients (63%), 16% had resting left ventricular (LV) dysfunction alone, and 21% had ischemia. Abnormalities were confined to one territory in 489 patients (21%) and to multiple territories in 365 patients (15%). Cardiac death was less frequent among the patients able to exercise than among those undergoing dobutamine echocardiography (4% versus 7%, PϽ0.001). The risk of death in patients with a negative stress echocardiogram was Ͻ1% per year. Ischemia identified by stress echocardiography was an independent predictor of mortality in those able to exercise (hazard ratio 2.21, 95% confidence intervals 1.10 to 4.43, Pϭ0.0001) as well as those undergoing dobutamine echo (hazard ratio 2.39, 95% confidence intervals 1.53 to 3.75, Pϭ0.0001); other predictors were age, heart failure, resting LV dysfunction, and the Duke treadmill score. In stepwise models replicating the sequence of clinical evaluation, the results of stress echocardiography added prognostic power to models based on clinical and stress-testing variables. Thus, the results of stress echocardiography are an independent predictor of cardiac death in hypertensive patients with known or suspected coronary artery disease, incremental to clinical risks and exercise results.

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Prediction of Outcomes in Hypertensive Patients With Suspected Coronary Disease

et al. 2002

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“…Very low (24%) specificity of exercise ECG in hypertensive patients was reported by Senior et al 3 In the group of hypertensive subjects with positive exercise stress test evaluated by Fragasso et al, 9 significant coronary artery disease was present in only 56%. This study confirms that specificity of exercise ECG in hypertensive subjects without previous myocardial infarction is quite low indeed.…”

Section: Discussionmentioning

confidence: 86%

“…Pepi et al 16 found that in hypertensive patients left ventricular wall motion abnormalities evoked by maximal bicycle exercise are 93% sensitive and 100% specific for significant coronary stenosis. Fragasso et al 9 reported on the high specificity of both dobutamine and dipyridamole in hypertensive patients with positive exercise ECG (80% and 91%). Zouridakis et al 17 who analysed a group of 18 hypertensive patients with normal coronary arteries and frequent (59%) positive Thallium SPECT result found normal left ventricular wall motion during dobutamine echocardiography in all cases.…”

Section: Discussionmentioning

confidence: 99%

Advantages of exercise echocardiography in comparison to dobutamine echocardiography in the diagnosis of coronary artery disease in hypertensive subjects

et al. 2001

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Objective: The aim of the study was to compare the efficacy and safety of two stress echocardiography methods, exercise and dobutamine, in the diagnosis of coronary artery disease in hypertensive patients with angina. Patients and methods: A total of 197 treated hypertensive patients, age 53 ؎ 9 years (65 women) with no history of myocardial infarction referred for coronary angiography were prospectively investigated with exercise electrocardiography (ECG), exercise and dobutamine echocardiography. Results: Sensitivity of the exercise ECG, exercise echocardiography and dobutamine echocardiography did not differ (77%, 82% and 75%). Negative predictive value of exercise ECG was significantly lower than exercise echocardiography (64% vs 79%, P Ͻ 0.01). Specificity and positive predictive value of exercise ECG were markedly lower than exercise and dobutamine echocar-

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“…Furthermore, it may very well be that ST depression that does not concur with angiographic findings or with other diagnostic modalities represents ST depression caused by microvascular abnormalities. [23][24][25] By following that line of reasoning, the reported low sensitivity of ECG investigations may be ready for revision by newer techniques that can measure flow at the tissue level (MRI, positron emission tomography).…”

Section: Boon Et Al Silent Ischemia In Hypertension 477mentioning

confidence: 99%

ST Segment Depression Criteria and the Prevalence of Silent Cardiac Ischemia in Hypertensives

et al. 2003

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Abstract-The reported prevalence of silent cardiac ischemia as assessed by ambulatory electrocardiographic recording varies widely. The influence of the stringency of the analysis criteria has never been reported. We performed 24-hour, 12-lead ambulatory electrocardiographic recording in patients with hypertension but without proven coronary artery disease. The recordings were analyzed according to strict ST segment depression criteria adapted from the American College of Cardiology/American Heart Association guidelines and according to basic ST segment depression criteria adapted from studies with only concise descriptions of ambulatory electrocardiographic recording analysis. Also, we performed 24-hour ambulatory blood pressure monitoring. More than 4400 hours of ambulatory electrocardiographic recording and ambulatory blood pressure monitoring in 194 patients with hypertension were analyzed. Medication was withdrawn in 45% of the patients. The average systolic blood pressure during the day was 152Ϯ13 (meanϮSD); diastolic blood pressure was 94Ϯ17 mm Hg. According to the basic ST segment depression criteria, we found a prevalence of silent ischemia of 11.3%, and with the strict criteria the prevalence was 5.2%. The patients who were considered positive according to the basic criteria but not according to the strict criteria (false-positive) in the majority of cases (58%) had depression of an elevated baseline ST segment. We found a lower prevalence of silent cardiac ischemia as assessed by ambulatory electrocardiographic recording than generally reported. The stringency of applied analysis criteria appear to play an important role in this outcome.

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Comparison of stress/rest myocardial perfusion tomography, dipyridamole and dobutamine stress echocardiography for the detection of coronary disease in hypertensive patients with chest pain and positive exercise test

Cited by 120 publications

References 24 publications

Prediction of Outcomes in Hypertensive Patients With Suspected Coronary Disease

Prediction of Outcomes in Hypertensive Patients With Suspected Coronary Disease

Advantages of exercise echocardiography in comparison to dobutamine echocardiography in the diagnosis of coronary artery disease in hypertensive subjects

ST Segment Depression Criteria and the Prevalence of Silent Cardiac Ischemia in Hypertensives

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