Stress echocardiographic results predict risk of reinfarction early after uncomplicated acute myocardial infarction: Large-scale multicenter study

Picaño, Eugenio; Pingitore, Alessandro; Sicari, Rosa; Minardi, Giovanni; Gandolfo, Nicola; Seveso, Giovanni; Chiarella, Francesco; Bolognese, Leonardo; Chiarandà, Giacomo; Sclavo, Maria Grazia; Previtali, Mario; Margaria, Franca; Magaia, Ornella; Bianchi, Federico; Pirelli, Salvatore; Severi, Silva; Raciti, Mauro; Landi, Patrizia; Vassalle, Cristina; Sousa, M.; Duarte, Luis Felipe de Moura

doi:10.1016/0735-1097(95)00293-2

Cited by 52 publications

(13 citation statements)

References 44 publications

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“…As expected and in keeping with previous extensive evidences,6, 7, 8, 9, 10, 11, 12, 13 a negative SE was associated with a significantly lower death rate compared with patients with positive SE. However, the 25‐year mortality difference between patients with SE positive versus those with SE negative results, albeit significant because of the large sample size, was modest: 70% versus 60% for all‐cause death and 40% versus 31% for cardiovascular death.…”

Section: Discussionsupporting

confidence: 91%

“…The prognostic value of SE was shown initially for cumulative end points, mainly consisting of soft end points such as recurrence of angina or coronary revascularization,5, 6, 7, 8 later for hard end points such as myocardial infarction (MI)9, 10 and—as data matured—for all‐cause death and cardiac death 11, 12, 13. The clinical meaning of the prognostic stratification is based not only on statistical but also on biological plausibility 14.…”

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confidence: 99%

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Stress Echocardiography Positivity Predicts Cancer Death

Carpeggiani

Landi

Michelassi

et al. 2017

JAHA

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BackgroundStress echocardiography (SE) predicts cardiac death, but an increasing share of cardiac patients eventually die of cancer. The aim of the study was to assess whether SE positivity predicts cancer death.Methods and ResultsIn a retrospective analysis of prospectively acquired single‐center, observational data, we evaluated 4673 consecutive patients who underwent SE from 1983 to 2009. All patients were cancer‐free at index SE and were followed up for a median of 131 months (interquartile range 134). We separately analyzed predetermined end points: cardiovascular, cancer, and noncardiovascular, noncancer death, with and without competing risk. SE was positive in 1757 and negative in 2916 patients; 869 cardiovascular, 418 cancer, and 625 noncardiovascular, noncancer deaths were registered. The 25‐year mortality was higher in SE‐positive than in SE‐negative patients, considering cardiovascular (40% versus 31%; P<0.001) and cancer mortality (26% versus 17%; P<0.01). SE positivity was a strong predictor of cancer (cause‐specific hazard ratio 1.19; 95% confidence interval, 1.16–1.73; P=0.05) and cardiovascular mortality (1.18; 95% confidence interval, 1.03–1.35; P=0.02). Fine–Gray analysis to account for competing risk gave similar results. Cancer risk diverged after 15 years, whereas differences were already significant at 5 years for cardiovascular risk.Conclusions SE results predict cardiovascular and cancer mortality. SE may act as a proxy of the shared risk factor milieu for cancer or cardiovascular death.

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Section: Discussionsupporting

confidence: 91%

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confidence: 99%

Stress Echocardiography Positivity Predicts Cancer Death

Carpeggiani

Landi

Michelassi

et al. 2017

JAHA

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“…Consequently, our results emphasize that adenosine/dipyridamole IWMAs are useful only for identifying patients with high-grade perfusion deficits who are at high risk for future cardiac events. 16,17 Yet, it should be stressed that assessment of patient prognosis alone does not sufficiently aid the cardiologist in clinical decision making. When aiming to follow the guidelines and apply current state-of-the-art treatment regimens of CAD, 18 it is important to evaluate the hemodynamic impact of coronary lesions with 50% to 75% diameter reduction.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Dobutamine Stress Magnetic Resonance, Adenosine Stress Magnetic Resonance, and Adenosine Stress Magnetic Resonance Perfusion

Paetsch¹,

Jahnke²,

Wahl³

et al. 2004

Circulation

295

151

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Background-Dobutamine stress MR (DSMR) is highly accurate for the detection of inducible wall motion abnormalities (IWMAs). Adenosine has a more favorable safety profile and is well established for the assessment of myocardial perfusion. We evaluated the diagnostic value of IWMAs during dobutamine and adenosine stress MR and adenosine MR perfusion compared with invasive coronary angiography. Methods and Results-Seventy-nine consecutive patients (suspected or known coronary disease, no history of prior myocardial infarction) scheduled for cardiac catheterization underwent cardiac MR (1.5 T). After 4 minutes of adenosine infusion (140 g · kg Ϫ1 · min Ϫ1 for 6 minutes), wall motion was assessed (steady-state free precession), and subsequently perfusion scans (3-slice turbo field echo-echo planar imaging; 0.05 mmol/kg Gd-BOPTA) were performed. After a 15-minute break, rest perfusion was imaged, followed by standard DSMR/atropine stress MR. Wall motion was classified as pathological if Ն1 segment showed IWMAs. The transmural extent of inducible perfusion deficits (Ͻ25%, 25% to 50%, 51% to 75%, and Ͼ75%) was used to grade segmental perfusion. Quantitative coronary angiography was performed with significant stenosis defined as Ͼ50% diameter stenosis. Fifty-three patients (67%) had coronary artery stenoses Ͼ50%; sensitivity and specificity for detection by dobutamine and adenosine stress and adenosine perfusion were 89% and 80%, 40% and 96%, and 91% and 62%, respectively. Adenosine IWMAs were seen only in segments with Ͼ75% transmural perfusion deficit. Conclusions-DSMR is superior to adenosine stress for the induction of IWMAs in patients with significant coronary artery disease. Visual assessment of adenosine stress perfusion is sensitive with a low specificity, whereas adenosine stress MR wall motion is highly specific because it identifies only patients with high-grade perfusion deficits. Thus, DSMR is the method of choice for current state-of-the-art treatment regimens to detect ischemia in patients with suspected or known coronary artery disease but no history of prior myocardial infarction.

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“…A presença de resultado negativo está associada a baixo risco de eventos cardiovasculares durante o acompanhamento, ao contrário do resultado positivo. Em pacientes com infarto miocárdico prévio, a ecocardiografia sob estresse pode ser útil na avaliação da presença, distribuição e seTabela XXIII -Indicações gerais da ecocardiografia sob estresse no diagnóstico e prognóstico da DAC crônica veridade da isquemia miocárdica, com importantes implicações prognósticas 54 . A ECO-estresse pela dobutamina é útil também na estratificação de risco pré-operatório de pacientes com DAC, sobretudo em cirurgias vasculares de grande porte 55 .…”

Section: Iamunclassified