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
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.