Pacemaker stress echocardiography predicts cardiac events in patients with permanent pacemaker - 21/08/11

Doi : 10.1016/j.amjmed.2005.04.040

Elena Biagini, MD ^a,^d, Arend F.L. Schinkel, MD ^a, Abdou Elhendy, MD ^a,^b, Jeroen J. Bax, MD ^c, Vittoria Rizzello, MD ^a, Ron T. van Domburg, PhD ^a, Boudewijn J. Krenning, MD ^a, Olaf Schouten, MD ^a, Angelo Branzi, MD ^d, Guido Rocchi, MD ^d, Maarten L. Simoons, MD ^a, Don Poldermans, MD ^a,^⁎
^a Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
^b Department of Internal Medicine, Section of Cardiology, University of Nebraska Medical Center, Omaha, Neb
^c Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
^d Institute of Cardiology, S. Orsola Hospital, Bologna, Italy

Requests for reprints should be addressed to Don Poldermans, MD, PhD, Department of Cardiology, Thoraxcenter Room Ba 300, Erasmus MC, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands

Abstract

Purpose

Noninvasive pacemaker stress echocardiography is a newly introduced method for the diagnosis of coronary artery disease in patients with a permanent pacemaker. The prognostic value of pacemaker stress echocardiography has not been studied.

Subjects and methods

We studied 136 patients (mean age 64±12 years) with a permanent pacemaker who underwent pacemaker stress echocardiography for evaluation of coronary artery disease. All patients underwent pacemaker stress echocardiography by external programming (pacing heart rate up to ischemia or target heart rate).

Results

Thirty-one patients (23%) had normal study results. Ischemia was detected in 75 patients (55%). During a mean follow-up of 3.5±2.4 years, 35 deaths (26%) (20 the result of cardiac causes) and 2 nonfatal myocardial infarctions (1%) occurred. The annual cardiac death rate was 1.3% in patients without ischemia and 4.6% in patients with ischemia (P=.01). The annual all-cause mortality rate was 3.1% in patients without ischemia and 7% in patients with ischemia (P=.004). The presence of ischemia during pacemaker stress echocardiography was the strongest independent predictor of cardiac death (hazard ratio 4.1, confidence interval 1.2-14.5) and all-cause mortality (hazard ratio 2.7, confidence interval 1.2-6.0) in a multivariable model.

Conclusion

Myocardial ischemia during pacemaker stress echocardiography is an independent predictor of cardiac death and all-cause mortality in patients with a permanent pacemaker.

Le texte complet de cet article est disponible en PDF.

Keywords : Stress testing, Echocardiography, Pacemaker, Prognosis

Plan

Material and methods

Patients

Pacemaker stress echocardiography

Follow-up

Statistical analysis

Results

Pacemaker stress echocardiography and outcome

Predictors of events

Discussion

Clinical implications and conclusions

Export

Vol 118 - N° 12

P. 1381-1386 - décembre 2005 Retour au numéro

Article précédent

Variability in the use of thromboprophylaxis and outcomes in critically ill medical patients
Krista L. Lentine, Kara E. Flavin, Michael K. Gould

| Article suivant

What do patients consider when making decisions about treatment for hepatitis C?
Liana Fraenkel, Sarah McGraw, Suchat Wongcharatrawee, Guadalupe Garcia-Tsao

Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.

Déjà abonné à cette revue ?

connectez-vous ou créez un compte

Pacemaker stress echocardiography predicts cardiac events in patients with permanent pacemaker - 21/08/11

Abstract

Purpose

Subjects and methods

Results

Conclusion

Plan

Export citations

Fichier

Contenu

Accès rapides

Mon compte

Aide & support

Plateformes Elsevier Masson

Déclaration CNIL