RESUMEN
BACKGROUND: The safety of ergonovine/ergometrine stress testing for coronary vasospasm when performed outside the cath lab has vigorously been questioned. The aim of this study was to assess the value of ergonovine/ergometrine stress testing performed in the echo lab. METHODS: We retrospectively reviewed the data prospectively collected in the echo lab of the Institute of Clinical Physiology of Pisa (Italy) from January 1, 1985, to October 1, 1998, on 478 tests performed on 464 patients with either ergonovine or ergometrine stress echo testing. By selection, all patients had history of chest pain, consistent with vasospastic angina, negative or ambiguous exercise stress testing, and normal or near normal resting left ventricular function. Ergonovine or ergometrine maleate was injected up to a total cumulative dosage of 0.35 mg, under continuous 12 lead ECG and two-dimensional echo monitoring. RESULTS: There were no death, myocardial infarction, ventricular fibrillation or III degree atrioventricular block. One patient had non-sustained ventricular tachycardia associated with transient ST segment elevation 30 min after the test. Two patients had II degree atrioventricular block, associated with positive echocardiography test and promptly reversed by nitrate administration. Transient regional myocardial dysfunction occurred in 74 patients (15%). Limiting ischemia-independent side effects were present in 13 patients (3%): hypotension in 1, arterial hypertension in 5, nonsustained ventricular tachycardia in 2, and nausea/vomiting in 5. The overall feasibility was 97%. CONCLUSIONS: Pharmacological stress echocardiography with either ergonovine or ergometrine is highly feasible and can be safely performed in the echo lab in properly selected patients in whom coronary vasospasm is suspected. It is often the only way to document coronary vasospasm otherwise missed by conventional noninvasive stress test and even by coronary angiography.
Asunto(s)
Enfermedad Coronaria/diagnóstico , Vasoespasmo Coronario/diagnóstico , Ecocardiografía/métodos , Angiografía Coronaria , Ergonovina , Prueba de Esfuerzo , Femenino , Humanos , MasculinoRESUMEN
When new technologies are added to the previously existing ones, the latter can be prematurely discarded and judged obsolete not only on the basis of rational scientific facts, but also on irrational trends. Old techniques, like electrocardiography, suffer from diagnostic ambiguities that can be solved by combination with a cardiac imaging technique, like stress echocardiography. ECG monitoring during all forms of stress testing can still offer surprising dividends for a better understanding of the complex physiology of coronary artery disease, a better clinical characterization of patients with microvascular angina, and may serve as an important adjunct marker to cardiac imaging techniques.
Asunto(s)
Enfermedad Coronaria/diagnóstico , Electrocardiografía/instrumentación , Prueba de Esfuerzo/instrumentación , Enfermedad Coronaria/fisiopatología , Diagnóstico por Imagen , Sistema de Conducción Cardíaco/fisiopatología , Hemodinámica/fisiología , Humanos , Procesamiento de Señales Asistido por Computador/instrumentaciónRESUMEN
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 (chi 2 = 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.