在评估稳定型冠心病预后时采用 ABCDE 方案进行负荷超声心动图检查。

IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS
O A Zhuravleva, T R Ryabova, A V Vrublevsky, N N Svyazova, N Y Margolis, A A Boshchenko
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引用次数: 0

摘要

目的:评估根据扩展方案进行的应力超声心动图检查的临床指标和参数作为预测心血管疾病综合终点(CCVEP)发生的作用:研究纳入了 186 名确诊(73 人,占 39.2%)和疑似确诊(60.8%)为 IHD 的患者(60.2% 为男性,平均年龄为 60.6±9.9 岁)。采用三磷酸腺苷(38.2%)、经食道起搏(15.1%)、多巴酚丁胺(2.6%)和卧式测力计上的自行车测力法(44.1%)进行了应激 EchoCG。负荷 EchoCG 方案包括评估区域室壁运动异常 (WMA)、B 线、左心室收缩储备 (CTR)、冠状动脉储备 (CR) 和心率储备。中位随访时间为 13 [9; 20] 个月。复合 CCVEP 包括心血管疾病及其并发症导致的死亡、急性冠状动脉综合征和血管重建,并在首次发生这些事件时定义。统计分析使用 Statistica 16.0 和 SPSS Statistics 23.0 软件包进行。P<0.05为差异有统计学意义:90.3%的患者进行了有创或无创冠状动脉造影;67.9%的病例发现了阻塞性冠状动脉疾病(狭窄≥50%)。在随访期间,58 例(31.2%)患者出现了心血管并发症。CCVEP的发病风险与缺血性心脏病的检测前概率(PTP)(比值比,OR,1.05;95% 置信区间,CI,1.02-1.08)、血脂异常(DLP)(OR,0.40;95% 置信区间,0.20-0.82)、颈动脉粥样硬化(OR,0.39;95% 置信区间,0.18-0.86)、左心室射血分数(LV ejection fraction,LV射血分数)(比值比,OR,1.05;95% 置信区间,1.02-1.08)、左心室射血分数(LV ejection fraction,LV射血分数)(比值比,OR,0.40;95% 置信区间,0.20-0.82)相关。86)、左心室射血分数(OR 0.96;95% CI 0.93-0.99)、压力峰值时出现新的显著(2 个左心室节段或更多)区域 WMA(OR 0.32;95% CI 0.18-6.55)、左心室 CTR 下降(OR 0.46;95% CI 0.27-0.79)和 CR(OR 0.33;95% CI 0.18-0.61);所有指标的 p<0.05。在Cox回归的多变量分析中,临床指标模型包括IHD的PTP(OR 1.04;95% CI 1.01-1.07;P=0.01)和DLP(OR 0.14;95% CI 0.02-1.01;P=0.05)作为预测因素。应激 EchoCG 参数模型包括出现新的显著 WMA(OR 0.33,95% CI 0.16-0.65;p=0.001)和 <2.0 CR 减少(OR 0.44;95% CI 0.24-0.82;p=0.01)。Kaplan-Meier曲线的比较分析证实,CCVEP发生的动态变化在统计学上存在显著差异,这取决于应激EchoCG时是否存在血流动力学意义上的WMA和/或CR降低(p<0.01):结论:疑似或确诊 IHD 患者应激 EchoCG 时左心室 CR 和 WMA 降低是 CCVEP 发生的重要独立预测因素。在临床指标中,IHD 的 PTP 和 DLP 对预后最为重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Stress Echocardiography by the ABCDE Protocol ln the Assessment of Prognosis of Stable Coronary Heart Disease.

Aim: To assess the role of clinical indicators and parameters of stress echocardiography performed according to an extended protocol as predictors for the occurrence of a composite cardiovascular endpoint (CCVEP) in IHD.

Material and methods: The study included 186 patients (60.2% men, mean age 60.6±9.9 years) with an established (n=73; 39.2%) and suspected (60.8%) diagnosis of IHD. Stress EchoCG with adenosine triphosphate (38.2%), transesophageal pacing (15.1%), dobutamine (2.6%), and bicycle ergometry on a recumbent ergometer (44.1%) was performed. The stress EchoCG protocol included assessment of regional wall motion abnormalities (WMA), B-lines, LV contractile reserve (CTR), coronary reserve (CR), and heart rate reserve. The median follow-up period was 13 [9; 20] months. The composite CCVEP included death from cardiovascular diseases and their complications, acute coronary syndrome, and revascularization and was defined at the first of these events. Statistical analysis was performed with the Statistica 16.0 and SPSS Statistics 23.0 software packages. Differences were considered statistically significant at p<0.05.

Results: Invasive or noninvasive coronary angiography was performed in 90.3% of patients; obstructive coronary disease (stenosis ≥50%) was detected in 67.9% of cases. During the follow-up period, 58 (31.2%) patients had cardiovascular complications. The risk of developing CCVEP was associated with the pretest probability (PTP) of ischemic heart disease (odds ratio, OR, 1.05; 95% confidence interval, CI, 1.02-1.08), dyslipidemia (DLP) (OR 0.40; 95% CI 0.20-0.82), carotid atherosclerosis (OR 0.39; 95% CI 0.18-0.86), LV ejection fraction (OR 0.96; 95% CI 0.93-0.99), appearance at peak stress of new significant (2 LV segments or more) regional WMAs (OR 0.32; 95% CI 0.18-6.55), decreased LV CTR (OR 0.46; 95% CI 0.27-0.79) and CR (OR 0.33; 95% CI 0.18-0.61); p<0.05 for all. In a multivariate analysis with Cox regression, the model with clinical indicators included PTP of IHD (OR 1.04; 95% CI 1.01-1.07; p=0.01) and DLP (OR 0.14; 95% CI 0.02-1.01; p=0.05) as predictors. The model with stress EchoCG parameters included the appearance of new significant WMAs (OR 0.33, 95% CI 0.16-0.65; p=0.001) and reduced <2.0 CR (OR 0.44; 95% CI 0.24-0.82; p=0.01). A comparative analysis of Kaplan-Meier curves confirmed statistically significant differences in the dynamics of the CCVEP occurrence depending on the absence or presence of hemodynamically significant WMAs and/or reduced CR during stress EchoCG (p<0.01).

Conclusion: Reduced LV CR and WMA during stress EchoCG in patients with suspected or confirmed IHD are significant independent predictors for the CCVEP occurrence. Among clinical indicators, PTP of IHD and DLP are of the greatest importance for prognosis.

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来源期刊
Kardiologiya
Kardiologiya 医学-心血管系统
CiteScore
1.70
自引率
20.00%
发文量
94
审稿时长
3-8 weeks
期刊介绍: “Kardiologiya” (Cardiology) is a monthly scientific, peer-reviewed journal committed to both basic cardiovascular medicine and practical aspects of cardiology. As the leader in its field, “Kardiologiya” provides original coverage of recent progress in cardiovascular medicine. We publish state-of-the-art articles integrating clinical and research activities in the fields of basic cardiovascular science and clinical cardiology, with a focus on emerging issues in cardiovascular disease. Our target audience spans a diversity of health care professionals and medical researchers working in cardiovascular medicine and related fields. The principal language of the Journal is Russian, an additional language – English (title, authors’ information, abstract, keywords). “Kardiologiya” is a peer-reviewed scientific journal. All articles are reviewed by scientists, who gained high international prestige in cardiovascular science and clinical cardiology. The Journal is currently cited and indexed in major Abstracting & Indexing databases: Web of Science, Medline and Scopus. The Journal''s primary objectives Contribute to raising the professional level of medical researchers, physicians and academic teachers. Present the results of current research and clinical observations, explore the effectiveness of drug and non-drug treatments of heart disease, inform about new diagnostic techniques; discuss current trends and new advancements in clinical cardiology, contribute to continuing medical education, inform readers about results of Russian and international scientific forums; Further improve the general quality of reviewing and editing of manuscripts submitted for publication; Provide the widest possible dissemination of the published articles, among the global scientific community; Extend distribution and indexing of scientific publications in major Abstracting & Indexing databases.
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