RESUMEN
Little is known about the association of echocardiographic estimates of right ventricular (RV) function with survival, in relation to hemodynamic and exercise-derived predictors of outcome in congestive heart failure. We prospectively studied 40 patients (age 55+/-10 years, in New York Heart Association functional class III [70%] and IV [30%]), with left ventricular (LV) ejection fraction <30%. At enrollment, all patients underwent echocardiographic evaluation of LV dimensions and function. RV shortening was measured as the difference of the end-diastolic distance - the end-systolic distance between the tricuspid annulus and the RV apex. Thirty-five patients (88%) were able to perform a maximal symptom-limited exercise test. Peak oxygen consumption (peak VO2) and percent peak age- and gender-adjusted predicted oxygen consumption (%peak VO2) were calculated. Of 40 patients, 10 died during a mean follow-up period of 14+/-10 months. On univariate analysis, nonsurvivors had lower RV shortening (p=0.0001), higher pulmonary artery wedge pressure (p=0.009), higher pulmonary vascular resistance (p=0.02), and lower mean aortic pressure (p=0.05). Cox proportional-hazards model revealed that the only independent associate of survival was RV shortening (p=0.0005), with a trend toward significance for mean aortic pressure (p=0.08). The best cutoff point of RV shortening identified by the receiver-operating curve was 1.25 cm. This value had a sensitivity of 90%, specificity of 80%, and overall predictive accuracy of 83% to distinguish survivors from nonsurvivors. In patients with advanced heart failure, preserved RV function as indicated by an echocardiographically derived RV shortening > 1.25 cm is a strong predictor of survival.
Asunto(s)
Insuficiencia Cardíaca/diagnóstico por imagen , Ventrículos Cardíacos/diagnóstico por imagen , Cateterismo Cardíaco , Gasto Cardíaco , Ecocardiografía , Prueba de Esfuerzo , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/fisiopatología , Ventrículos Cardíacos/metabolismo , Ventrículos Cardíacos/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Contracción Miocárdica , Consumo de Oxígeno , Pronóstico , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/fisiopatología , Presión Esfenoidal Pulmonar , Tasa de Supervivencia , Resistencia VascularRESUMEN
BACKGROUND: Exercise-induced ST-segment changes 3 months after angioplasty may sometimes show a false-positive result. METHODS: We therefore analyzed the ST changes observed during the exercise tests performed before and 3 months after angioplasty in 118 patients with single-vessel coronary artery disease. RESULTS: Ninety-two (78%) of the 118 patients had ST changes in the same lead before and after angioplasty, whereas the remaining 26 (22%) patients had ST changes in other leads in the postangioplasty test when compared with the preangioplasty exercise test. Restenosis was found in 44 (48%) of the 92 patients with ST changes in the some lead but in only four (15%) of the 26 patients with ST changes in other leads. CONCLUSIONS: Exercise-induced ST-segment changes are not reliable markers of restenosis 3 months after angioplasty. ST-segment changes observed in other leads after angioplasty compared with the preangioplasty exercise test may show a false-positive result.
Asunto(s)
Angioplastia Coronaria con Balón , Enfermedad Coronaria/diagnóstico , Electrocardiografía , Adulto , Anciano , Enfermedad Coronaria/terapia , Prueba de Esfuerzo , Reacciones Falso Positivas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Reproducibilidad de los ResultadosRESUMEN
Exercise-induced ST-segment changes 3 months after angioplasty sometimes may show a false-positive result. We therefore analyzed the ST changes observed during the exercise tests performed before and 3 months after angioplasty in 118 patients with single-vessel coronary artery disease. Ninety-two (78%) of the 118 patients had ST changes in the same lead before and after angioplasty, whereas the remaining 26 (22%) patients had ST changes in other leads in the postangioplasty exercise test when compared with the preangioplasty test. Restenosis was found in 44 (48%) of the 92 patients with ST changes in the same lead but in only 4 (15%) of the 26 patients with ST changes in other leads. We conclude that exercise-induced ST segment changes are not reliable markers of restenosis 3 months after angioplasty. ST segment changes observed in other leads after angioplasty may show a false-positive result when compared with the preangioplasty exercise test.
