74 research outputs found
Dobutamine-atropine stress echocardiography : a method for preoperative cardiac risk stratification in patients undergoing major vascular surgery
Atherosclerosis is a systemic disease that may affect several blood vessels in
different organs simultaneously. The spectrum of disease ranges from stroke to
myocardial infarction, aortic aneurysms and peripheral vascular insufficiency.
Patients suffering from one aspect of atherosclerotic disease will often have
asymptomatic lesions elsewhere. Most patients seen with vascular disease by the
internist or surgeon have a high prevalence of coronary artery disease, for
example, 40-70% of patients undergoing major vascular surgery without
clinically evident coronary artery disease will indeed have angiographically
demonstrable coronary artery stenosisl
. The coronary artery disease may be
dormant due to lack of exercise but will undoubtedly have an impact on the
management of patients. In patients undergoing vascular surgery coronary artery
disease contributes to both perioperative and late death.
The number of patients with vascular disease and concomitant coronary artery
disease is increasing as the prevalence of cardiovascular diseases increases with
age, and the population of Europe is aging rapidly. The number of people over
60 years of age in Europe will probably increase with more than 92 million to
224 million in the year 20252
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Conventional testing in patients with vascular disease for coronary artery
disease by exercise stress tests is often impossible due to noncardiac disease.
Most patients are suffering from claudication or neurological disease
Beta-blockers and health-related quality of life in patients with peripheral arterial disease and COPD
Yvette RBM van Gestel1, Sanne E Hoeks1, Don D Sin2, Henk Stam3, Frans W Mertens3, Jeroen J Bax4, Ron T van Domburg5, Don Poldermans61Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands; 2Department of Medicine, University of British Columbia and The James Hogg iCAPTURe Center, St. Paul’s Hospital, Vancouver, Canada; 3Department of Pulmonology, Erasmus Medical Center, Rotterdam, The Netherlands; 4Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; 5Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands; 6Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, The NetherlandsBackground: Beta-blockers are frequently withheld in patients with cardiovascular disease who also have chronic obstructive pulmonary disease (COPD) because of concerns that they might provoke bronchospasm and cause deterioration in health status. Although beta1-selective beta-blockers are associated with reduced mortality in COPD patients, their effects on health status are unknown. The aim of this study was to investigate the relationship between beta-blockers and health-related quality of life (HRQOL) in patients with peripheral arterial disease and COPD.Methods: Of the original cohort of 3371 vascular surgery patients, 1310 had COPD of whom 469 survived during long-term follow-up. These COPD patients were sent the Short Form-36 (SF-36) health-related quality of life questionnaire, which was completed and returned by 326 (70%) patients.Results: No significant differences in any of the SF-36 domains were observed between COPD patients who did and did not use beta-blockers (p > 0.05 for all). Furthermore, beta-blockers were not associated with any impairment in HRQOL among patients with COPD.Conclusion: Beta-blockers had no material impact on the HRQOL of patients with peripheral arterial disease who also had COPD. This suggests that beta-blockers can, in most circumstances, be administered to patients with COPD without impairment in HRQOL. Keywords: beta-blockers, chronic obstructive pulmonary disease, vascular surgery, health-related quality of lif
Long-term prognostic value of dobutamine stress echocardiography in patients with atrial fibrillation
STUDY OBJECTIVE: To assess the long-term prognostic value of dobutamine
stress echocardiography (DSE) for cardiac events (cardiac death,
myocardial infarction, and late revascularization) in patients with atrial
fibrillation (AF). METHODS: Baseline ECGs were studied in patients
undergoing DSE between 1989 and 1998. Sixty-nine patients had AF before
DSE. Prognostic value of DSE in these patients was compared with a control
group who had sinus rhythm (n = 1,664). The presence of stress-induced
ischemia was noted for every patient. The mean follow-up period was 35
months (range, 6 to 84 months). Data are presented as hazards ratio (HR)
with 95% confidence interval (CI). RESULTS: Heart rate at rest was higher
in patients with AF (77 +/- 15 beats/min vs 73 +/- 14 beats/min; p =
0.04); however, double product at peak stress was not different between
patients with AF and sinus rhythm (17,602 vs 17,169, respectively; p =
0.46). In patients with AF, target heart rate was achieved at a lower
dobutamine dose (33 +/- 8 microg/kg/min vs 35 +/- 9 microg/kg/min; p =
0.01). Cardiac arrhythmias occurred more frequently (12% vs 5%; p = 0.001)
in patients with AF during DSE. During a follow-up period of 7 years,
cardiac death occurred in 5 patients, myocardial infarction in 2 patients,
and late revascularization in 10 patients. Prognostic value of DSE for all
late cardiac events was similar in patients with AF (HR, 3.0; 95% CI, 0.9
to 9.5) and sinus rhythm (HR, 3.4; 95% CI, 2.7 to 4.3; p = 0.85).
CONCLUSION: The prognostic value of DSE for late cardiac events is
maintained in patients with AF
Long-term prognostic value of dobutamine-atropine stress echocardiography in 1737 patients with known or suspected coronary artery disease: A single-center experience
BACKGROUND--The purpose of this study was to assess the long-term value of
dobutamine-atropine stress echocardiography (DSE) for prediction of late
cardiac events in patients with proven or suspected coronary artery
disease. METHODS AND RESULTS--Clinical data and DSE results were analyzed
in 1734 consecutive patients undergoing DSE between 1989 and 1997.
Seventy-four patients who underwent revascularization within 3 months of
DSE and 1 patient lost to follow-up were excluded; the remaining 1659
(median age, 62 years; range, 14 to 99 years) were followed up for 36
months (range, 6 to 96 months). Wall motion abnormalities at rest and the
presence and extent of stress-induced wall motion abnormalities (ischemia)
were scored for each patient. Cardiac events were related to clinical and
ECG data and DSE results. Four hundred twenty-eight cardiac events
occurred in 366, documented cardiac death in 108 (total death, 247),
nonfatal infarction in 128, and late revascularization in 192 patients. In
a multivariable Cox proportional-hazards model, the ratio of documented
cardiac death or (re)infarction was increased in the presence of
stress-induced ischemia (hazard ratio, 3.3; 95% CI, 2.4 to 4.4) and
extensive rest wall motion abnormalities (hazard ratio, 1.9; 95% CI, 1.3
to 2.6). The number of ischemic segments was predictive for late cardiac
events. A normal DSE carried a relatively good prognosis, wit
Noninvasive evaluation of ischaemic heart disease: myocardial perfusion imaging or stress echocardiography?
Stress echocardiography and myocardial perfusion imaging are commonly used noninvasive imaging modalities for the evaluation of ischaemic heart disease. Both modalities have proved clinically useful in the entire spectrum of coronary artery disease. Both techniques can detect coronary artery disease and provide prognostic information. Both techniques can identify low-risk and high-risk subsets among patients with known or suspected coronary artery disease and thus guide patient management decisions. In patients with acute myocardial infarction, both techniques have been used to identify residual viable tissue and predict improvement of function over time. In patients with chronic ischaemic left ventricular (LV) dysfunction, viability assessment with either modality can be used to predict improvement of function after revascularisation and thus guide patient treatment
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