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The prognostic role of stress echocardiography in a contemporary population and the clinical significance of limited apical ischaemia

机译：应力超声心动图在当代人群中的预后作用及根尖局限性缺血的临床意义

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IntroductionIn this study, we aim to reassess the prognostic value of stress echocardiography (SE) in a contemporary population and to evaluate the clinical significance of limited apical ischaemia, which has not been previously studied.MethodsWe included 880 patients who underwent SE. Follow-up data with regards to MACCE (cardiac death, myocardial infarction, any repeat revascularisation and cerebrovascular accident) were collected over 12 months after the SE. Mortality data were recorded over 27.02?±?4.6 months (5.5–34.2 months). We sought to investigate the predictors of MACCE and all-cause mortality.ResultsIn a multivariable analysis, only the positive result of SE was predictive of MACCE (HR, 3.71; P?=?0.012). The positive SE group was divided into 2 subgroups: (a) inducible ischaemia limited to the apical segments (‘apical ischaemia’) and (b) ischaemia in any other segments with or without apical involvement (‘other positive’). The subgroup of patients with apical ischaemia had a significantly worse outcome compared to the patients with a negative SE (HR, 3.68; P?=?0.041) but a similar outcome to the ‘other positive’ subgroup. However, when investigated with invasive coronary angiography, the prevalence of coronary artery disease (CAD) and their rate of revascularisation was considerably lower. Only age (HR, 1.07; P??0.001) was correlated with all-cause mortality.ConclusionSE remains a strong predictor of patients’ outcome in a contemporary population. A positive SE result was the only predictor of 12-month MACCE. The subgroup of patients with limited apical ischaemia have similar outcome to patients with ischaemia in other segments despite a lower prevalence of CAD and a lower revascularisation rate.
机译：引言在本研究中，我们旨在重新评估应力超声心动图（SE）在当代人群中的预后价值，并评估先前尚未研究的有限的根尖缺血的临床意义。方法我们纳入了880例接受SE的患者。在SE后12个月内收集有关MACCE（心脏死亡，心肌梗塞，任何重复的血运重建和脑血管意外）的随访数据。死亡率数据记录在27.02±4.6个月（5.5-34.2个月）内。结果我们进行了多变量分析，只有SE的阳性结果才是MACCE的预测指标（HR，3.71; P = 0.012）。阳性SE组分为两个亚组：（a）诱导性局部缺血仅限于心尖段（“心尖缺血”）和（b）任何其他有或没有心尖累及的段（“其他阳性”）缺血。与SE阴性的患者（HR，3.68; P？=？0.041）相比，顶部缺血的亚组的结局明显更差，但与“其他阳性”的亚组的结局相似。但是，当用侵入性冠状动脉造影术进行调查时，冠状动脉疾病（CAD）的患病率及其血运重建率要低得多。只有年龄（HR，1.07; P <0.001）与全因死亡率相关。结论SE仍然是现代人群中患者预后的有力预测指标。 SE阳性的结果是12个月MACCE的唯一预测指标。尽管CAD患病率较低且血运重建率较低，但根尖局限性缺血的患者亚组的结局与其他阶段的缺血性患者相似。

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