AIMS: Patients with normal coronary arteries have a heterogeneous prognosis. Aim of this study was to assess whether dipyridamole stress echocardiography positivity identifies a prognostically less benign subset. METHODS AND RESULTS: We selected 457 patients (245 males; 56+/-10 years) who underwent stress high-dose dipyridamole echocardiography and had angiographically non-significant (<50% visually assessed) stenosis in any major vessel and preserved left ventricular function. All patients were followed up for a median of 7.1 years (first quartile 5 and third quartile 10.5). Dipyridamole echocardiography test (DET) positivity for regional dysfunction occurred in 43(9%) patients. Kaplan-Meier survival estimates showed a significant better outcome for those patients with negative dipyridamole echocardiography test compared with those with a positive test (90 vs. 75.7%, at 140 months of follow-up, P=0.0018). At multivariable analysis, mild or moderate irregularity on coronary arteriogram (HR=3.3, CI 95%=1.7-6.2), diabetes (HR=3.5, CI 95%=1.4-9.2), and wall motion score index at peak stress (HR=6.7, CI 95%=2.5-17.8) were independent predictors of all-cause death. CONCLUSION: DET adds incremental value to the prognostic stratification achieved with clinical and angiographic data in the subset of patients with normal or near-normal coronary arteries.
AIMS: Patients with normal coronary arteries have a heterogeneous prognosis. Aim of this study was to assess whether dipyridamole stress echocardiography positivity identifies a prognostically less benign subset. METHODS AND RESULTS: We selected 457 patients (245 males; 56+/-10 years) who underwent stress high-dose dipyridamole echocardiography and had angiographically non-significant (<50% visually assessed) stenosis in any major vessel and preserved left ventricular function. All patients were followed up for a median of 7.1 years (first quartile 5 and third quartile 10.5). Dipyridamole echocardiography test (DET) positivity for regional dysfunction occurred in 43(9%) patients. Kaplan-Meier survival estimates showed a significant better outcome for those patients with negative dipyridamole echocardiography test compared with those with a positive test (90 vs. 75.7%, at 140 months of follow-up, P=0.0018). At multivariable analysis, mild or moderate irregularity on coronary arteriogram (HR=3.3, CI 95%=1.7-6.2), diabetes (HR=3.5, CI 95%=1.4-9.2), and wall motion score index at peak stress (HR=6.7, CI 95%=2.5-17.8) were independent predictors of all-cause death. CONCLUSION: DET adds incremental value to the prognostic stratification achieved with clinical and angiographic data in the subset of patients with normal or near-normal coronary arteries.
Authors: Harmony R Reynolds; Michael H Picard; John A Spertus; Jesus Peteiro; Jose Luis Lopez Sendon; Roxy Senior; Mohammad C El-Hajjar; Jelena Celutkiene; Michael D Shapiro; Patricia A Pellikka; Dennis F Kunichoff; Rebecca Anthopolos; Khaled Alfakih; Khaled Abdul-Nour; Michel Khouri; Leonid Bershtein; Mark De Belder; Kian Keong Poh; John F Beltrame; James K Min; Jerome L Fleg; Yi Li; David J Maron; Judith S Hochman Journal: Circulation Date: 2021-06-01 Impact factor: 39.918
Authors: Paul I Musey; Fernanda Bellolio; Suneel Upadhye; Anna Marie Chang; Deborah B Diercks; Michael Gottlieb; Erik P Hess; Michael C Kontos; Bryn E Mumma; Marc A Probst; John H Stahl; Jason P Stopyra; Jeffrey A Kline; Christopher R Carpenter Journal: Acad Emerg Med Date: 2021-07-06 Impact factor: 5.221