ABSTRACT
OBJECTIVE: The purpose was to determine the sensitivity, the specificity and a year-long risk of subsequent cardiovascular events in patients with low, intermediate and high risk prognostic Duke treadmill score (DTS) in comparison with the presence (or not) of the myocardial perfusion defects on radionuclide images. METHODS: A prospective study, with 173 consecutive patients with 02 or more risk factors to coronary artery disease (CAD), who underwent to exercise single photon - emission computed tomographic myocardial perfusion images using technetium-99m tetrophosmin (SPECT) and treadmill test (with DTS), from one neighbourhood of Curitiba city, between January 2003 and February 2004, were followed up for cardiac-cause mortality and major cardiac events. Follow-up was performed in 13+/- 1 months and in 162 patients was complete. RESULTS: The DTS mean those patients with cardiac event (18) over a year was -0.27 (95% CI= -3.97 to +3.91) and those free cardiac event patients (144) was +4.92 (95% CI= +4.03 to +5.81), with p<0.00069. The DTS sensitivity was 72.22% and the SPECT sensitivity was 77.78%, with no significant difference p=0.21. The DTS specificity was 54.17% and the SPECT specificity was 88.19%, with p<0.0001. The cumulative proportion free-events (Kaplan-Meier) curves demonstrated that 94% those patients with low-risk DTS remained free-cardiac events. In contrast, all high-risk DTS had adverse cardiac events. Those patients with intermediate-risk DTS had 15% of cardiac event over a year. CONCLUSIONS: The DTS was as sensitivity as SPECT in determine a year risk for CAD. Those patients with DTS <-0.27 had high-risk cardiac event.
Subject(s)
Coronary Artery Disease/diagnostic imaging , Exercise Test , Heart/diagnostic imaging , Radiopharmaceuticals , Technetium Tc 99m Sestamibi , Tomography, Emission-Computed, Single-Photon , Coronary Artery Disease/etiology , Epidemiologic Methods , Female , Humans , Male , Middle Aged , PrognosisABSTRACT
OBJETIVO: Determinar a sensibilidade, a especificidade e o risco de eventos cardiovasculares em pacientes com Duke-escore (DE) baixo, intermediário e alto risco, em comparação com a presença (ou não) de defeitos de perfusão à cintilografia do miocárdio. MÉTODOS: Estudo prospectivo, consecutivo, com 173 pacientes com 2 ou mais fatores de risco para doença arterial coronariana (DAC), que foram submetidos à cintilografia de perfusão do miocárdio com tetrofosmin marcado com tecnécio-Tc 99m (CPM) e ao teste ergométrico (aplicando-se o DE), de um bairro de Curitiba, entre janeiro de 2003 a fevereiro de 2004. Os pacientes tiveram seguimento de 13±1 meses e 162 completaram o acompanhamento. Foi avaliada a presença de morte, angina, infarto agudo do miocárdio, angioplastia coronariana e revascularização do miocárdio. RESULTADOS: A média do DE dos pacientes que apresentaram eventos (18) foi de -0,27 (95 por cento IC= -3,97 a +3,91) e daqueles livres de eventos (144) foi de +4,92 (95 por cento IC= +4,03 a +5,81), com p<0,00069. A sensibilidade do DE foi de 72,22 por cento e da CPM foi de 77,78 por cento, sem diferença estatística, com p=0,21. A especificidade do DE foi de 54,17 por cento e a da CPM foi de 88,19 por cento, com p<0,0001. A curva de Kaplan-Meier demonstrou que 94 por cento dos pacientes com DE baixo risco permaneceram livres de eventos em 01 ano. Em contraste, todos os de alto risco apresentaram eventos no mesmo período. Os que apresentaram DE de intermediário risco apresentaram 15 por cento de eventos em 01 ano. CONCLUSÃO: O DE foi tão sensível quanto CPM em determinar o risco para DAC em um ano. Os pacientes com DE <-0,27 tiveram maior risco de eventos cardíacos.
Subject(s)
Female , Humans , Male , Middle Aged , Coronary Artery Disease , Exercise Test , Heart , Radiopharmaceuticals , Tomography, Emission-Computed, Single-Photon , Coronary Artery Disease/etiology , Epidemiologic Methods , PrognosisABSTRACT
OBJECTIVE: To determine the most sensitive criterion for the detection of left ventricular hypertrophy according to echocardiographically defined left ventricular mass. METHODS: The Sokolow-Lyon voltage, Sokolow-Lyon-Rappaport, Cornell voltage duration product, White-Bock, and Romhilt-Estes point scoring criteria were compared with left ventricular mass index, corrected for body surface, obtained from the echocardiograms of 306 outpatients (176 females, 130 males), of all age groups. RESULTS: The Cornell voltage duration product criteria index had the greatest sensitivity in women (54.90%), and the Sokolow-Lyon-Rappaport index was most sensitive in men (73.53%). When applied to men at the same voltage amplitude (20mm) as that in women, the Cornell index showed increased sensitivity relative to the conventional index (28mm) of 67.65% (P
Subject(s)
Electrocardiography/methods , Hypertrophy, Left Ventricular/diagnosis , Adolescent , Adult , Age Distribution , Child , Child, Preschool , Female , Heart Ventricles/anatomy & histology , Humans , Hypertrophy, Left Ventricular/epidemiology , Hypertrophy, Left Ventricular/physiopathology , Infant , Infant, Newborn , Male , Middle Aged , Predictive Value of Tests , Sensitivity and Specificity , Sex DistributionABSTRACT
OBJECTIVE: To determine the most sensitive criterion for the detection of left ventricular hypertrophy according to echocardiographically defined left ventricular mass. METHODS: The Sokolow-Lyon voltage, Sokolow-Lyon-Rappaport, Cornell voltage duration product, White-Bock, and Romhilt-Estes point scoring criteria were compared with left ventricular mass index, corrected for body surface, obtained from the echocardiograms of 306 outpatients (176 females, 130 males), of all age groups. RESULTS: The Cornell voltage duration product criteria index had the greatest sensitivity in women (54.90 percent), and the Sokolow-Lyon-Rappaport index was most sensitive in men (73.53 percent). When applied to men at the same voltage amplitude (20mm) as that in women, the Cornell index showed increased sensitivity relative to the conventional index (28mm) of 67.65 percent (P<=0.01) and a sensitivity similar to that of the Sokolow-Lyon-Rappaport index, with higher specificity (P<=0.01). The White-Bock and Romhilt-Estes criteria were the least sensitive in men and women, despite their high specificity. The electrocardiographic criteria were more efficient when dilatation predominated over left ventricular hypertrophy. CONCLUSION: The Cornell index had greater sensitivity in women, and the Sokolow-Lyon-Rappaport index was more sensitive in men. When applied to men at the same voltage amplitude as that of women, the Cornell index had an increase in sensitivity similar to that of the Sokolow-Lyon-Rappaport index
