Prognostic significance of myocardial ischaemia during exercise echocardiography in the absence of angiographic evidence of obstructive coronary disease.

European heart journal. Imaging methods and practice Pub Date : 2025-05-12 eCollection Date: 2025-01-01 DOI:10.1093/ehjimp/qyaf055
Alaa Mabrouk Salem Omar, Robert Leber, Nitin Barman, Edgar Argulian
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Abstract

Aims: We studied the prognostic significance of myocardial ischaemia during exercise stress echocardiography (ExE) in the absence of angiographic evidence of obstructive coronary artery disease (CAD) in a contemporary cohort of patients.

Methods and results: We retrospectively enrolled 84 patients who underwent ExE and had exercise-induced myocardial ischaemia followed by angiographic coronary evaluation. Fifty-one (61%) patients had non-obstructive CAD (iNOCAD), and 33 (39%) had normal coronaries (iNC). iNC and NOCAD patients were propensity matched to 99 and 153 patients with non-ischaemic ExE, respectively. Compared to iNOCAD, iNC patients were younger (60.9 ± 10.4 vs. 68 ± 8.9 years, P = 0.002) and predominantly women (76% vs. 47%, P = 0.009). Ejection fraction (57 ± 9.4 vs. 56.4 ± 6, P = 0.776) as well as other clinical and demographic variables were similar. During median follow-up of 3.2 years, there were 27 composite adverse cardiovascular events (1 death, 10 acute chest pain events, 2 strokes, and 21 cardiac hospitalizations). iNC was associated with a higher risk of acute chest pain (HR: 19.0, 95% CI: 3.7-93) and the composite adverse outcome (HR: 3.3, 95% CI: 1.7-6.6), compared to matched patients. Similarly, iNOCAD was associated with a higher risk of the composite outcome (HR: 2.2, 95% CI: 1.2-4.2).

Conclusion: Ischaemic ExE in the absence of angiographically obstructive CAD carries an elevated risk of adverse cardiovascular events necessitating medical optimization and close follow-up for progression.

Abstract Image

在没有阻塞性冠状动脉疾病血管造影证据的情况下,运动超声心动图心肌缺血的预后意义。
目的:我们研究了在没有阻塞性冠状动脉疾病(CAD)血管造影证据的当代患者队列中,运动应激超声心动图(ExE)期间心肌缺血的预后意义。方法和结果:我们回顾性地招募了84例接受ExE治疗并有运动引起的心肌缺血的患者,随后进行了冠状动脉造影评估。51例(61%)患者为非阻塞性CAD (iNOCAD), 33例(39%)患者为冠状动脉正常(iNC)。iNC和NOCAD患者分别与99例和153例非缺血性ExE患者倾向匹配。与iNOCAD相比,iNC患者更年轻(60.9±10.4岁vs. 68±8.9岁,P = 0.002),以女性为主(76% vs. 47%, P = 0.009)。射血分数(57±9.4比56.4±6,P = 0.776)及其他临床和人口学变量相似。在中位随访3.2年期间,共有27例心血管不良事件(1例死亡,10例急性胸痛事件,2例中风,21例因心脏病住院)。与匹配的患者相比,iNC与更高的急性胸痛风险(HR: 19.0, 95% CI: 3.7-93)和复合不良结局(HR: 3.3, 95% CI: 1.7-6.6)相关。同样,iNOCAD与复合结局的高风险相关(HR: 2.2, 95% CI: 1.2-4.2)。结论:在没有血管造影阻塞性CAD的情况下,缺血性ExE会增加不良心血管事件的风险,需要进行医学优化和密切随访。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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