The relative value of exercise-electrocardiography and dipyridamole stress echocardiography for risk stratification early after uncomplicated myocardial infarction

Eugenio Picano, Rosa Sicari, Monica Baroni, Blanca Del Negro, Claudio Michelassi, Salvatore Pirelli, Giacomo Chiarandà, Mario Previtali, Giovanni Seveso, Nicola Gandolfo, Cristina Vassalle, Franca Margaria, Ornella Magaia, Federico Bianchi, Giovanni Minardi, Patrizia Landi, Mauro Raciti, Silva Severi

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background. Rational prognostic algorithm should be developed considering the logical progression of the information as it becomes available to the physician, with clinical data first, ECG data second and stress imaging data last. The aim of the present study was to assess in a clinically realistic fashion the relative prognostic value of exercise electrocardiography test (EET) and dipyridamole-echocardiography test (DET) early after first acute uncomplicated myocardial infarction. Methods and results. Five hundred and forty-seven in-hospital patients (age = 56 ± 9 years) with recent clinically uncomplicated first myocardial infarction, baseline echocardiographic findings of satisfactory quality, interpretable ECG and capability to exercise underwent a resting 2D echocardiogram, a DET and an EET at a mean of 10 days from the infarction and were followed up for 16.2 ± 11 months. During the follow-up, there were 17 cardiac deaths, 19 non-fatal myocardial infarctions and 49 unstable angina. When cardiac death was considered as the only significant event, with multivariate analysis, peak dipyridamole Wall Motion Score Index was the only significant predictor (χ2 = 5.66; p = 0.013; relative risk estimate = 4.7; confidence intervals = 1.35-16.08). In presence of a negative exercise electrocardiography test for both chest pain and electrocardiographic criteria, the death rate was 2%. Conclusion. DET provides stronger information in comparison with historical and EET variables. However, a negative maximal EET is sufficient to identify a very low risk subset in whom additional testing may not be warranted.

Original languageEnglish
Pages (from-to)32-39
Number of pages8
JournalGiornale Italiano di Cardiologia
Volume27
Issue number1
Publication statusPublished - Jan 1997

Fingerprint

Stress Echocardiography
Dipyridamole
Electrocardiography
Myocardial Infarction
Exercise Test
Exercise
Echocardiography
Unstable Angina
Chest Pain
Infarction
Multivariate Analysis
Confidence Intervals
Physicians
Mortality

Keywords

  • dipyridamole
  • exercise
  • infarction
  • prognosis
  • stress echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

The relative value of exercise-electrocardiography and dipyridamole stress echocardiography for risk stratification early after uncomplicated myocardial infarction. / Picano, Eugenio; Sicari, Rosa; Baroni, Monica; Del Negro, Blanca; Michelassi, Claudio; Pirelli, Salvatore; Chiarandà, Giacomo; Previtali, Mario; Seveso, Giovanni; Gandolfo, Nicola; Vassalle, Cristina; Margaria, Franca; Magaia, Ornella; Bianchi, Federico; Minardi, Giovanni; Landi, Patrizia; Raciti, Mauro; Severi, Silva.

In: Giornale Italiano di Cardiologia, Vol. 27, No. 1, 01.1997, p. 32-39.

Research output: Contribution to journalArticle

Picano, E, Sicari, R, Baroni, M, Del Negro, B, Michelassi, C, Pirelli, S, Chiarandà, G, Previtali, M, Seveso, G, Gandolfo, N, Vassalle, C, Margaria, F, Magaia, O, Bianchi, F, Minardi, G, Landi, P, Raciti, M & Severi, S 1997, 'The relative value of exercise-electrocardiography and dipyridamole stress echocardiography for risk stratification early after uncomplicated myocardial infarction', Giornale Italiano di Cardiologia, vol. 27, no. 1, pp. 32-39.
Picano, Eugenio ; Sicari, Rosa ; Baroni, Monica ; Del Negro, Blanca ; Michelassi, Claudio ; Pirelli, Salvatore ; Chiarandà, Giacomo ; Previtali, Mario ; Seveso, Giovanni ; Gandolfo, Nicola ; Vassalle, Cristina ; Margaria, Franca ; Magaia, Ornella ; Bianchi, Federico ; Minardi, Giovanni ; Landi, Patrizia ; Raciti, Mauro ; Severi, Silva. / The relative value of exercise-electrocardiography and dipyridamole stress echocardiography for risk stratification early after uncomplicated myocardial infarction. In: Giornale Italiano di Cardiologia. 1997 ; Vol. 27, No. 1. pp. 32-39.
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abstract = "Background. Rational prognostic algorithm should be developed considering the logical progression of the information as it becomes available to the physician, with clinical data first, ECG data second and stress imaging data last. The aim of the present study was to assess in a clinically realistic fashion the relative prognostic value of exercise electrocardiography test (EET) and dipyridamole-echocardiography test (DET) early after first acute uncomplicated myocardial infarction. Methods and results. Five hundred and forty-seven in-hospital patients (age = 56 ± 9 years) with recent clinically uncomplicated first myocardial infarction, baseline echocardiographic findings of satisfactory quality, interpretable ECG and capability to exercise underwent a resting 2D echocardiogram, a DET and an EET at a mean of 10 days from the infarction and were followed up for 16.2 ± 11 months. During the follow-up, there were 17 cardiac deaths, 19 non-fatal myocardial infarctions and 49 unstable angina. When cardiac death was considered as the only significant event, with multivariate analysis, peak dipyridamole Wall Motion Score Index was the only significant predictor (χ2 = 5.66; p = 0.013; relative risk estimate = 4.7; confidence intervals = 1.35-16.08). In presence of a negative exercise electrocardiography test for both chest pain and electrocardiographic criteria, the death rate was 2{\%}. Conclusion. DET provides stronger information in comparison with historical and EET variables. However, a negative maximal EET is sufficient to identify a very low risk subset in whom additional testing may not be warranted.",
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T1 - The relative value of exercise-electrocardiography and dipyridamole stress echocardiography for risk stratification early after uncomplicated myocardial infarction

AU - Picano, Eugenio

AU - Sicari, Rosa

AU - Baroni, Monica

AU - Del Negro, Blanca

AU - Michelassi, Claudio

AU - Pirelli, Salvatore

AU - Chiarandà, Giacomo

AU - Previtali, Mario

AU - Seveso, Giovanni

AU - Gandolfo, Nicola

AU - Vassalle, Cristina

AU - Margaria, Franca

AU - Magaia, Ornella

AU - Bianchi, Federico

AU - Minardi, Giovanni

AU - Landi, Patrizia

AU - Raciti, Mauro

AU - Severi, Silva

PY - 1997/1

Y1 - 1997/1

N2 - Background. Rational prognostic algorithm should be developed considering the logical progression of the information as it becomes available to the physician, with clinical data first, ECG data second and stress imaging data last. The aim of the present study was to assess in a clinically realistic fashion the relative prognostic value of exercise electrocardiography test (EET) and dipyridamole-echocardiography test (DET) early after first acute uncomplicated myocardial infarction. Methods and results. Five hundred and forty-seven in-hospital patients (age = 56 ± 9 years) with recent clinically uncomplicated first myocardial infarction, baseline echocardiographic findings of satisfactory quality, interpretable ECG and capability to exercise underwent a resting 2D echocardiogram, a DET and an EET at a mean of 10 days from the infarction and were followed up for 16.2 ± 11 months. During the follow-up, there were 17 cardiac deaths, 19 non-fatal myocardial infarctions and 49 unstable angina. When cardiac death was considered as the only significant event, with multivariate analysis, peak dipyridamole Wall Motion Score Index was the only significant predictor (χ2 = 5.66; p = 0.013; relative risk estimate = 4.7; confidence intervals = 1.35-16.08). In presence of a negative exercise electrocardiography test for both chest pain and electrocardiographic criteria, the death rate was 2%. Conclusion. DET provides stronger information in comparison with historical and EET variables. However, a negative maximal EET is sufficient to identify a very low risk subset in whom additional testing may not be warranted.

AB - Background. Rational prognostic algorithm should be developed considering the logical progression of the information as it becomes available to the physician, with clinical data first, ECG data second and stress imaging data last. The aim of the present study was to assess in a clinically realistic fashion the relative prognostic value of exercise electrocardiography test (EET) and dipyridamole-echocardiography test (DET) early after first acute uncomplicated myocardial infarction. Methods and results. Five hundred and forty-seven in-hospital patients (age = 56 ± 9 years) with recent clinically uncomplicated first myocardial infarction, baseline echocardiographic findings of satisfactory quality, interpretable ECG and capability to exercise underwent a resting 2D echocardiogram, a DET and an EET at a mean of 10 days from the infarction and were followed up for 16.2 ± 11 months. During the follow-up, there were 17 cardiac deaths, 19 non-fatal myocardial infarctions and 49 unstable angina. When cardiac death was considered as the only significant event, with multivariate analysis, peak dipyridamole Wall Motion Score Index was the only significant predictor (χ2 = 5.66; p = 0.013; relative risk estimate = 4.7; confidence intervals = 1.35-16.08). In presence of a negative exercise electrocardiography test for both chest pain and electrocardiographic criteria, the death rate was 2%. Conclusion. DET provides stronger information in comparison with historical and EET variables. However, a negative maximal EET is sufficient to identify a very low risk subset in whom additional testing may not be warranted.

KW - dipyridamole

KW - exercise

KW - infarction

KW - prognosis

KW - stress echocardiography

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