Relative value of clinical variables, bicycle ergometry, rest radionuclide ventriculography and 24 hour ambulatory electrocardiographic monitoring at discharge to predict 1 year survival after myocardial infarction

Fioretti, P.; Brower, R. W.; Simoons, Maarten L.; Katen, Harald ten; Beelen, Anita; Baardman, Taco; Lubsen, Jacobus; Hugenholtz, Paul G.

doi:10.1016/s0735-1097(86)80089-4

Cited by 84 publications

(12 citation statements)

References 27 publications

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“…We believe that this is further support for a better contractile reserve in these patients, because the extent and severity of fixed sestamibi perfusion defects are known to be related to prognosis. 6 The more significant results in prediction of survival by systolic BP response in exercise studies 15,16 can be a result of different (postmyocardial infarction) patient populations and the presence of the Bezold-Jarisch reflex, which will be more prevalent in patients stressed with a strong inotropic agent such as dobutamine, and in patients with preserved left ventricular rest function and contractile reserve. Indeed, this reflex will flaw the expected increase in systolic BP in more ''normal'' patients.…”

Section: Resultsmentioning

confidence: 99%

“…[12][13][14] An increase in systolic BP was defined as an increase of ¢30 mm Hg from rest to peak, also in accordance with previous (exercise) studies. 15,16 Reasons for interruption of the test were: horizontal or downsloping ST-segment depression ú0.2 mV at an interval of 80 ms after the J point compared with baseline, ST-segment elevation ú0.1 mV in patients without previous myocardial infarction, severe angina, a symptomatic reduction in systolic BP ú40 mm Hg, hypertension (BP ú240/120 mm Hg), and significant tachyarrhythmias.…”

Section: Methodsmentioning

confidence: 99%

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Prognostic Significance of Systolic Blood Pressure Changes During Dobutamine-Atropine Stress Technetium-99m Sestamibi Perfusion Scintigraphy in Patients With Chest Pain and Known or Suspected Coronary Artery Disease

Geleijnse

Elhendy

Domburg

et al. 1997

The American Journal of Cardiology

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To investigate the prognostic value of dobutamine stressinduced changes in systolic blood pressure (BP) 418 patients (mean age 60 years, 238 men) with chest pain and known or suspected coronary artery disease, who underwent a dobutamine-atropine stress technetium99m sestamibi myocardial perfusion scintigraphic study, were followed up for 25 { 15 months. Blood pressure was measured by automatic sphygmomanometry every 3 minutes. A marked decrease and increase in systolic BP from rest to peak were defined as changes of ¢20 mm Hg, and ¢30 mm Hg, respectively. Worst outcome events were cardiac death (n Å 30), nonfatal myocardial infarction (n Å 17), and hospitalization for congestive heart failure (n Å 8). A decrease in systolic BP (prevalence 16%) was associated with older age and higher baseline systolic BP. Fixed and reversible sestamibi perfusion defects and follow-up results were similar to patients without a systolic BP decrease. In contrast, an increase in systolic BP (prevalence 24%) was associated with younger age, lower baseline systolic BP, and with absence of a history of prior congestive heart failure or treatment with angiotensin-converting enzyme inhibitors. Furthermore, these patients had fewer fixed perfusion defects and tended to have fewer annual event rates (3.5% vs 7.5%, p õ0.10). In a multivariate model, an increase in systolic BP was not an independent predictor for subsequent events. In conclusion, a dobutamine-induced decrease in systolic BP is not associated with fixed or reversible sestamibi defects or adverse prognosis. An increase in systolic BP, however, is associated with less fixed sestamibi defects and a tendency toward less annual event rates. ᮊ1997 by Excerpta Medica, Inc.(Am J Cardiol 1997;79:1031-1035) D obutamine stress technetium-99m sestamibi myocardial perfusion scintigraphy is a pharmacologic stress modality with diagnostic 1-5 and prognostic 6 properties comparable to dobutamine stress echocardiography. Previous dobutamine stress echocardiographic studies have reported that dobutamine stress-induced hypotension is -unlike exercise -induced hypotension 7 -10 not related to new or worsening wall motion abnormalities 11 -14 and the presence or extent of coronary artery disease. 11,12Furthermore, a relatively small echocardiographic study 12 has supported these results with prognostic data that were similar for the hypotensive and the nonhypotensive group. To date, however, these findings were not confirmed by myocardial perfusion scintigraphic data. Also, it is not known whether a substantial increase in systolic blood pressure (BP)From the Thoraxcentre and the Department of Nuclear Medicine, University Hospital, Rotterdam-Dijkzigt and Erasmus University, Rotterdam, The Netherlands. This study was supported in part by funds from the Dutch Heart Foundation (Grant NHS 94.135), The Hague, The Netherlands, and Cairo University Hospital, Cairo, Egypt. Manuscript received July 16, 1996; revised manuscript received and accepted December 12, 1996.Address for reprints: Marcel L. Geleijn...

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Prognostic Significance of Systolic Blood Pressure Changes During Dobutamine-Atropine Stress Technetium-99m Sestamibi Perfusion Scintigraphy in Patients With Chest Pain and Known or Suspected Coronary Artery Disease

Geleijnse

Elhendy

Domburg

et al. 1997

The American Journal of Cardiology

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“…Nevertheless, a great deal of evidence supports the concept that clinical history and in-hospital course can identify those at greatest risk, for which an aggressive diagnostic and therapeutic approach is advisable' 6 "" 8 ' 10 '"' 25 '. Patients with uncomplicated myocardial infarction represent an increasing population in the thrombolytic era and are at low or intermediate risk of subsequent cardiac events' 26 '.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of residual ischaemia assessed by exercise electrocardiography and dobutamine stress echocardiography in low-risk patients following acute myocardial infarction

Bigi

Galati

Curti

et al. 1997

European Heart Journal

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Background Risk stratification after uncomplicated myocardial infarction is a major clinical problem. In particular, the prognostic value of residual inducible ischaemia is still controversial. We compared the relative prognostic value of exercise ECG and dobutamine stress echocardiography performed in the early post-infarction period.Methods Four hundred and six patients (53 female) aged 57 ± 9 years, undergoing maximal exercise ECG and dobutamine stress echocardiography within 10 days of an uncomplicated myocardial infarction off therapy, were prospectively followed-up for 8-8 months. Age, sex, diabetes, smoking habit, hypertension, dyslipidaemia, infarct location, thrombolysis and resting wall motion score index were taken into account among clinical variables. Prognostic correlations were made vs spontaneous events (cardiac death, non-fatal reinfarction and unstable angina requiring hospitalization) whilst patients undergoing revascularization (by means of percutaneous transluminal coronary angioplasty or coronary artery bypass surgery) at the time of the procedure were censored.Results One hundred and twenty-seven events occurred during the follow-up: 41 (10%) were spontaneous (five deaths, 12 reinfarctions and 24 unstable angina) and 86 procedural (27 angioplasty and 59 bypass surgery). Spontaneous events were not predicted by any clinical, exercise ECG or dobutamine stress echocardiography variable, but the negative predictive value of both tests was excellent (91% and 90%, respectively). With a multivariate Cox analysis, male gender, positive low-workload (<100W) exercise ECG (/><00001), positive low-dose dobutamine stress echocardiography (P<00001) and reststress wall motion score index variation (P<0001) were found to predict cumulative cardiac events with an independent and additive value. Dobutamine stress echocardiography was significantly more sensitive (P<005) and less specific (P<001) in predicting the outcome of patients with anterior infarction, whilst exercise ECG was significantly more sensitive (P<005) in patients with non-Q wave infarction. Conclusions(1) Spontaneous events are poorly predicted by provocative tests in low-risk patients after uncomplicated myocardial infarction. (2) However, both exercise ECG and dobutamine stress echocardiography can predict a favourable outcome with a very high negative predictive value. (3) Dobutamine stress echocardiography should be considered a secondary option in cases where the exercise ECG is equivocal or when the location of ischaemia is a relevant issue. (4) The possibility that the two tests have a differential utility depending on the infarct location and type (Q wave vs non-Q wave) may be clinically relevant and deserves further evaluation.

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“…Left ventricular ejection fraction (EF) is one of the most important indices for the assessment and prognosis of acquired heart disease [1][2][3], The quantitative applica tion of two-dimensional (2D) echocardiography is a useful noninvasive method of evaluating EF (ECHO-EF) [4][5][6][7][8][9]. However, all of the echocardiographic algorithms are not easily applicable to routinely practice.…”

Section: Introductionmentioning

confidence: 99%

Two-Dimensional Echocardio-graphic Evaluation of Left Ventricular Ejection Fraction by the Ellipsoid Single-Plane Algorithm: A Reliable Method for Assessing Low or Very Low Ejection Fraction Values?

Corrao

Paterna²,

Arnone³

et al. 1995

Cardiology

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The reliability of two-dimensional (2D) echocardiographic estimation of left ventricular ejection fraction (EF) is commonly recognized, but no satisfactory data are available about the accuracy of low or very low EF values determined by 2D echocardiography (ECHO-EF). The purpose of our study was to assess the reliability of low ECHO-EF values obtained using a simple time-economical algorithm such as the ellipsoid single-plane area-length method. Radionuclide angiography (RAD-EF) was taken as the standard of comparison. We studied 59 consecutive patients (31 women and 28 men) referred to our echocardiographic laboratory. Both 2D echocardiography and radionuclide angiography were blindly performed within 48 h of one another. EF was calculated by the two methods and then compared. Data were globally analyzed. Furthermore, data were divided and analyzed according to the ECHO-EF cut-off point of 50%. An ECHO-EF value of 50% was chosen to conventionally distinguish between low ECHO-EF values and normal-high ones. Data were plotted, and the line of equality and the regression lines were drawn. Regression line slopes, correlation coefficients, means and standard deviations were calculated. The agreement was analyzed by calculating the mean difference (RAD-EF – ECHO-EF) and the standard deviation of the differences. ECHO-EF was linearly related to RAD-EF even when data were split. In particular, as regards ECHO-EF < 50%, the regression line practically overlapped the line of equality, and the two methods showed both a strong correlation and a good degree of agreement. Regarding ECHO-EF > 50%, the association between the two methods was lower and the slope of the regression line was quite different from the line of equality. In conclusion, echocardiographic estimation of EF using the ellipsoid single-plane area-length method seems to be sufficiently accurate to evaluate low or very low EF values. For normal-high values, this method underestimated EF calculated using radionuclide angiography, and it showed a minor degree of agreement.

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Relative value of clinical variables, bicycle ergometry, rest radionuclide ventriculography and 24 hour ambulatory electrocardiographic monitoring at discharge to predict 1 year survival after myocardial infarction

Cited by 84 publications

References 27 publications

Prognostic Significance of Systolic Blood Pressure Changes During Dobutamine-Atropine Stress Technetium-99m Sestamibi Perfusion Scintigraphy in Patients With Chest Pain and Known or Suspected Coronary Artery Disease

Prognostic Significance of Systolic Blood Pressure Changes During Dobutamine-Atropine Stress Technetium-99m Sestamibi Perfusion Scintigraphy in Patients With Chest Pain and Known or Suspected Coronary Artery Disease

Prognostic value of residual ischaemia assessed by exercise electrocardiography and dobutamine stress echocardiography in low-risk patients following acute myocardial infarction

Two-Dimensional Echocardio-graphic Evaluation of Left Ventricular Ejection Fraction by the Ellipsoid Single-Plane Algorithm: A Reliable Method for Assessing Low or Very Low Ejection Fraction Values?

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