RESUMO
OBJECTIVES: The objective of this prospective study was to determine the differences in the prognostic significance of an exercise test (ET) that indicates a low risk of events (low-risk exercise test [LRET]) between patients with unstable angina (UA) and those with chronic stable angina (CSA). BACKGROUND: It is not known whether the prognostic significance of an LRET is influenced by the disease; that is the reason for performing exercise testing. METHODS: All patients not presenting with high-risk criteria were submitted to a prognostic ET. The ET was performed by patients with CSA and patients with primary UA stabilized with medical therapy. Medical therapy was planned for all patients. A combined end point was defined as cardiac death, nonfatal acute myocardial infarction or hospital admission for UA. Multivariate analysis was performed to determine the independent predictors of events. RESULTS: Low-risk criteria were fulfilled by 105 patients with UA and 86 patients with CSA. The mean follow-up time was 347 +/- 229 days. The event rate was higher in the UA group than in the CSA group (28% vs. 9%, p = 0.001). The CSA group showed worse ET results. Performance of ET by patients with UA was the principal predictor of events (odds ratio 4.2, p = 0.0005). CONCLUSIONS: Among patients who underwent an LRET, those with UA had a rate of events significantly higher than that of patients with CSA, despite the worse results of ET in patients with CSA.
Assuntos
Angina Pectoris/diagnóstico , Angina Instável/diagnóstico , Eletrocardiografia , Teste de Esforço , Idoso , Angina Pectoris/mortalidade , Angina Pectoris/fisiopatologia , Angina Instável/mortalidade , Angina Instável/fisiopatologia , Causas de Morte , Doença Crônica , Feminino , Sistema de Condução Cardíaco/fisiopatologia , Hemodinâmica/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/fisiopatologia , Admissão do Paciente/estatística & dados numéricos , Prognóstico , Medição de Risco , Taxa de SobrevidaRESUMO
A fifty-eight year old patient presented subacute right heart failure. Transthoracic and transesophageal echocardiography revealed thrombi in both atria, and initial anticoagulation and subsequent surgical treatment were successful. Echocardiography is defined as being decisive to diagnosis, and the role of surgery in the treatment of these patients is commented.