Valor prognóstico da ecocardiografia sob estresse físico em portadores de bloqueio do ramo esquerdo

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BackgroundExercise test (ET) is the preferred initial noninvasive test for the diagnosis and risk stratification of coronary artery disease (CAD), however, its lower sensitivity may fail to identify patients at greater risk of adverse events. ObjectiveTo assess the value of stress echocardiography (SE) for predicting all-cause mortality and major cardiac events (MACE) in patients with intermediate pretest probability of CAD and a normal ET. Methods397 patients with intermediate CAD pretest probability, estimated by the Morise score, and normal ET who underwent SE were studied. The patients were divided into two groups according to the absence (G1) or presence (G2) of myocardial ischemia on SE .End points evaluated were all-cause mortality and MACE, defined as cardiac death and nonfatal acute myocardial infarction (AMI). ResultsG1 group was comprised of 329 (82.8%) patients. The mean age of the patients was 57.37 ± 11 years and 44.1% were male. During a mean follow-up of 75.94 ± 17.24 months, 13 patients died, three of them due to cardiac causes, and 13 patients suffered nonfatal AMI. Myocardial ischemia remained an independent predictor of MACE (HR 2.49; [CI] 95% 1.74-3.58). The independent predictors for all-cause mortality were male gender (HR 9.83; [CI] 95% 2.15-44.97) and age over 60 years (HR 4.57; [CI] 95% 1.39-15.23). ConclusionPositive SE for myocardial ischemia is a predictor of MACE in the studied sample, which helps to identify a subgroup of patients at higher risk of events despite having normal ET.

Section: Discussionmentioning

confidence: 99%

Stress Echocardiography and Major Cardiac Events in Patients with Normal Exercise Test

Calasans¹,

Santos²,

Silveira³

et al. 2013

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“…24 The risk classifications for coronary syndrome followed the recommendations by Knuuti et al 5 Although ECG tracings at rest with the presence of left bundle branch block or changes in the ST segment represent limitations 25 to the aforementioned ECG criteria, in these cases, the other segments that did not involve these findings were analyzed, given the applicability of ESE as a predictor of coronary syndrome in these scenarios. 2 , 26 …”

Section: Methodsmentioning

confidence: 99%

Section: Métodosunclassified

“…24 As classificações de risco para SC seguiram o que é preconizado em Knuuti et al 5 Apesar de traçados elétricos ao repouso com a presença de bloqueio de ramo esquerdo ou de alterações do segmento ST representarem limitações 25 aos critérios elétricos mencionados, nestes casos os demais segmentos que não envolvessem tais achados eram analisados, haja vista a aplicabilidade da EEF enquanto preditora de SC nestes cenários. 2,26 Ecocardiografia sob estresse físico O protocolo experimental básico consistia na realização de ECG de doze derivações e de ecocardiograma de repouso após a avaliação clínica. Em seguida, realizava-se o esforço físico em esteira rolante e, imediatamente após (em 30 segundos a 1 minuto), procedia-se a aquisição das imagens ecocardiográficas no pós-esforço imediato por um período de 2 a 5 minutos em esquema de análise simultânea ("side by side") com as imagens obtidas no repouso para avaliação comparativa da contratilidade segmentar do ventrículo esquerdo como preconizado pela Sociedade Americana de Ecocardiografia.…”

Section: Características Clínicasunclassified

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Resposta Exagerada da Pressão Arterial Sistólica ao Exercício e Isquemia Miocárdica à Ecocardiografia sob Estresse Físico

Martins-Santos,

Duarte,

Ferreira-Junior

et al. 2023

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“…Among these are coronary atherosclerosis, which comprises a series of inflammatory responses at cellular and molecular level, of which reactions are further exacerbated in obese patients 18 , 19 . Physical stress echocardiography has been widely used in the noninvasive investigation of the CAD 20 . Physical exertion is the triggering agent of cardiovascular stress of choice for individuals with preserved physical capacity, as it results in greater increase in inotropism and provides physiological information about the presence, location and extent of ischemia 21 , 22 .…”

Section: Introductionmentioning

confidence: 99%

Assessment of myocardial ischemia in obese individuals undergoing physical stress echocardiography (PSE)

Silveira¹,

Sousa²,

Santos³

et al. 2015

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BackgroundPhysical stress echocardiography is an established methodology for diagnosis and risk stratification of coronary artery disease in patients with physical capacity. In obese (body mass index ≥ 30 kg/m2) the usefulness of pharmacological stress echocardiography has been demonstrated; however, has not been reported the use of physical stress echocardiography in this growing population group.ObjectiveTo assess the frequency of myocardial ischemia in obese and non-obese patients undergoing physical stress echocardiography and compare their clinical and echocardiographic differences.Methods4,050 patients who underwent treadmill physical stress echocardiography were studied according to the Bruce protocol, divided into two groups: obese (n = 945; 23.3%) and non-obese (n = 3,105; 76.6%).ResultsThere was no difference regarding gender. Obese patients were younger (55.4 ± 10.9 vs. 57.56 ± 11.67) and had a higher frequency of hypertension (75.2% vs. 57, 2%; p < 0.0001), diabetis mellitus (15.2% vs. 10.9%; p < 0.0001), dyslipidemia (59.5% vs 51.9%; p < 0.0001), family history of coronary artery disease (59.3% vs. 55.1%; p = 0.023) and physical inactivity (71.4% vs. 52.9%, p < 0.0001). The obese had greater aortic dimensions (3.27 vs. 3.14 cm; p < 0.0001), left atrium (3.97 vs. 3.72 cm; p < 0.0001) and the relative thickness of the ventricule (33.7 vs. 32.8 cm; p < 0.0001). Regarding the presence of myocardial ischemia, there was no difference between groups (19% vs. 17.9%; p = 0.41). In adjusted logistic regression, the presence of myocardial ischemia remained independently associated with age, female gender, diabetes and hypertension.ConclusionObesity did not behave as a predictor of the presence of ischemia and the physical stress echocardiography. The application of this assessment tool in large scale sample demonstrates the feasibility of the methodology, also in obese.