Poster display II

2000 European Journal of Echocardiography  
Rationale. The aim of this study was to determine whether exercise echocardiography provides incremental data for risk stratification of patients with suspected coronary artery disease (CAD) who are determined to have a low pretest probability. Methods. The study included 1618 patients with<0.25 probability of CAD referred for symptom-limited treadmill exercise echocardiography. Mean age was 55+_13 years. There were 571 men and 1047 women. Ischemia was defied as new or worsening wall motion
more » ... rmalities. Outcomes recorded during the follow up were hard events (cardiac death and non-fatal myocardial infarction) and coronary revascularization. Results. Cardiac events occurred in 56 patients (6 cardiac deaths, 13 non-fatal myocardial infarction, and 37 revascularization) during a median follow-up of 3 years. In the multivariate analysis of clinical, exercise and echocardiographic parameters, independent predictors of the combined endpoint of all cardiac events were the percentage of ischemic segments by echocardiography (Chi2=56, p=0.0001), peak exercise heart rate (Chi2=33, p=0.0001), ischemic ECG changes (Chi2=30, p=0.0001), male gender (Chi2=9, p=0.004) and resting systolic blood pressure >140 mmHg (Chi2=4, p=0.04). Independent predictors of hard events were exercise wall motion score index (Chi2=20, p=0.0001) and age (Chi2=10, p=0.001). Conclusion. Exercise echocardiography is a valuable tool for the risk stratification of patients with suspected CAD who have a low pretest probability. Peak exercise heart rate and ischemic ECG change during exercise provide incremental data to the clinical variables. The extent and severity of exercise-induced wall motion abnormalities are strong predictors of cardiac events, and provide incremental value to clinical and exercises stress test data. Ischemia detected by exercise echocardiography but not by ECG was predictive of hard events in this population. Abnormal intraventricular flow velocities in patients with angina-like symptoms and angiographically normal coronary arteries The human aortic (ao) root is nourished by vasa vasorum (w) originating from the coronary arteries (CA). Experimental w flow disruption has been shown to cause prompt deterioration of ao root elasticity; By contrast, the effects of spontaneous vv flow disruption are unknown. To investigate this issue, the following approach was undertaken: Transthoracic echo and CA angiogram were performed in 60 pts (age 56.5-+10.9 years, 52 male) with AMI as their first CAD event. ]'we indices of regional ao mechanics were calculated: Ao distensibility (AD)=2 x (pulsatile change in ao diameter) / ( x ); Ao strain=pulsatile change of ao diameter / diastolic ao diameter. Diameters were measured by M-mode echo at 3.5 cm above the ao valve; Blood pressure (BP) was measured by brachial artery sphygmomanometry. Carotid-femoral pulse wave velocity (PWV) was determined as an index of overall ao stiffness. Considering available anatomic data on the origin of human ao vv (origin in proximal parts of the CA; predominant contribution of the left CA), pts were grouped according to culprit lesion location in group A: lesion in proximal LAD, middle LAD or proximal Lcx (n=32 pts), and group B: lesion in distal LAD, distal Lcx or entire RCA (n=28 pts). Regional and overall ao function indices were compared between the 2 groups. Pts in group A were older (59.2-+10.7 vs 53.4-+10.7 years, p=0.04) and had lower LVEF (0.39_+0.1 vs 0.45-+0.08, p=0.02). Results: Groups did not differ regarding ao dimensions, BP, heart rate, prevalence of risk factors, risk factor sum per pt, CAD extent, culprit CA patency status, and drug treatment on the day of the echo. Both indices of regional ao elasticity were significantly lower in group A vs B (AD: 1.17-+0.68 vs. 1.70-+0.70 dynes-t .cm2.10-6, p=0.005; strain: 2.92±1.78% vs. 4.45-+1.55%, p=0.001). PWV did not differ between groups (10.0-+2.9 vs. 10.6-+4.2 m/s, p=NS). Multiple regression analysis identified lesion location (A vs B) (b=-0.49, p<0.001) and pulse pressure (b=-0.39, p=0.004) as significant independent predictors of AD. Lesion location was the only significant predictor of aortic strain (b=-0.54, p<0.001). Age was the only significant predictor of PWV (b=0.54, p=0.009). Indices of regional ao root elasticity correlated poorly with PWV. Our data suggest that the ao root is influenced by CA occlusion, particularly when the latter regards the central parts of the left CA. Clinical implications of these findings concern post-MI undermining of ao root wall integrity. Abstracts $31 212 The assessment of left ventricular function by dynamic and pharmacological stress echocardiography in survivors for childhood cancer L. E/b/ r, H. Hrstkov# 2, V. Chaloupka 1, j. Novotn~' a Cardiopulmona~ *p < 0,001 at comparison with parameters in the prestenotic zone Eur J Echocardiography Euroecho 4 Abstracts, December 2000 transluminal angioplasty of femoropopliteal arterial obstruction T.
doi:10.1016/s1525-2167(00)80007-4 fatcat:y25jbtzsd5egxm5khdvqt4yplu