Dipyridamole stress echocardiography for risk stratification in hypertensive patients with chest pain

L. Cortigiani et al., Dipyridamole stress echocardiography for risk stratification in hypertensive patients with chest pain, CIRCULATION, 98(25), 1998, pp. 2855-2859
Citations number
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Journal title
ISSN journal
0009-7322 → ACNP
Year of publication
2855 - 2859
SICI code
Background-The noninvasive prognostic assessment of coronary artery disease (CAD) in hypertensive patients represents an unresolved task to date. In t his study, we investigated the value of dipyridamole stress echocardiograph y in risk stratification of hypertensive patients with chest pain and unkno wn CAD. Methods and Results-Dipyridamole stress echocardiography was performed in 2 57 hypertensives (110 men; age, 63+/-9 years) complaining of chest pain and without a history of CAD. No major complications occurred. Four tests were interrupted prematurely because of side effects, with 98.4% feasibility of test. A positive echocardiographic response was found in 72 patients (27 d uring the low-dose [less than or equal to 0.56 mg/kg] and 45 during the hig h-dose [>0.56 mg/kg]). During the follow-up (32+/-18 months), 27 cardiac ev ents occurred: 3 deaths, 8 infarctions, and 16 cases of unstable angina. Mo reover, 27 patients underwent coronary revascularization. At multivariate a nalysis, the positive echocardiographic result (OR, 5.5; 95% CI, 1.4 to 16. 6) was the only predictor of hard cardiac events (death, infarction). Consi dering spontaneous cardiac events (death, infarction, and unstable angina) as end points, the positive echocardiographic result (OR, 4.2; 95% CI, 1.8 to 9.6) and family history of CAD (OR, 4.2; 95% CI, 1.5 to 6.9) were indepe ndently associated with prognosis. The S-year survival rates for the negati ve and the positive populations were, respectively, 97% and 87% (P=0.0019) considering hard cardiac events and 96% and 74% (P=0.0000) considering spon taneous cardiac events. Conclusions-Dipyridamole stress echocardiography is safe, highly feasible, and effective in risk stratification of hypertensives with chest pain and u nknown CAD. At present, it represents an attractive option for prognostic a ssessment of this clinically defined population.