SIGNIFICANCE OF MYOCARDIAL ISCHEMIC ELECTROCARDIOGRAPHIC CHANGES DURING DIPYRIDAMOLE STRESS ECHOCARDIOGRAPHY

Citation
L. Cortigiani et al., SIGNIFICANCE OF MYOCARDIAL ISCHEMIC ELECTROCARDIOGRAPHIC CHANGES DURING DIPYRIDAMOLE STRESS ECHOCARDIOGRAPHY, The American journal of cardiology, 82(9), 1998, pp. 1008-1012
Citations number
24
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiac & Cardiovascular System
ISSN journal
0002-9149
Volume
82
Issue
9
Year of publication
1998
Pages
1008 - 1012
Database
ISI
SICI code
0002-9149(1998)82:9<1008:SOMIEC>2.0.ZU;2-Q
Abstract
The aim of this study was to assess the diagnostic and prognostic valu e of the presence and characteristics of ischemic electrocardiographic (ECG) changes during dipyridamole stress echocardiography. The ECG re sponse in 178 patients with echocardiographic evidence of myocardial i schemia during dipyridamole stress testing was analyzed, ECG changes o ccurred in 105 patients (59%). patients with ECG changes had a higher incidence of echocardiographic signs of ischemia at a low dose than pa tients with an unchanged electrocardiogram (50% vs 23%; p = 0.0002). T hree-vessel and/or left main coronary artery disease (CAD) was found i n 41% of patients with and in 21% of patients without ECG changes (p = 0.029). During follow-up (33 +/- 19 months), 30 cardiac events occurr ed: 10 deaths, 6 infarctions, and 14 unstable anginas, Coronary revasc ularization was performed in 48 patients with and in 17 patients witho ut ECG changes (p = 0.0022). The univariate predictors of cardiac even ts were: presence of ischemia in greater than or equal to 4 ECG leads (p = 0.0004), echocardiographic evidence of ischemia at a low dose (p = 0.0062), ST-segment shift on precordial leads (p = 0.0094), family h istory of CAD (p = 0.0115), coexistence of greater than or equal to 3 cardiovascular risk factors (p = 0.0156), ST-segment depression (p = 0 .0172), and ECG changes during testing (p = 0.0335). At Cox analysis, occurrence of ischemia at a low dose (odds ratio 3.0; 95% confidence i nterval 1.3 to 6.8) and the presence of ischemia in greater than or eq ual to 4 ECG leads (odds ratio 3.5; 95% confidence interval 1.3 to 9.3 ) had an independent prognostic importance. In conclusion, the presenc e and characteristics of ischemic ECG changes are associated with more extensive CAD and worse prognostic outlook than are echocardiographic changes alone during dipyridamole stress echocardiography. (C)1998 by Excerpta Medica, Inc.