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European Heart Journal Advance Access published online on July 13, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi408
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received January 4, 2005
Revised April 28, 2005
Accepted June 16, 2005

Clinical research

Long-term survival of patients with chest pain syndrome and angiographically normal or near-normal coronary arteries: the additional prognostic value of dipyridamole echocardiography test (DET)

Rosa Sicari 1*, Attila Palinkas 2, Emilio G. Pasanisi 1, Lucia Venneri 1, and Eugenio Picano 1

1 CNR, Institute of Clinical Physiology, Via G. Moruzzi 1, 56123 Pisa, Italy
2 Internal Medicine Department, Elisabeth Hospital, Hódmezõvásárhely, Hungary

* To whom correspondence should be addressed.
Rosa Sicari, E-mail: rosas{at}ifc.cnr.it


  Abstract

Aims Patients with normal coronary arteries have a heterogeneous prognosis. Aim of this study was to assess whether dipyridamole stress echocardiography positivity identifies a prognostically less benign subset.

Methods and results We selected 457 patients (245 males; 56 ± 10 years) who underwent stress high-dose dipyridamole echocardiography and had angiographically non-significant (<50% visually assessed) stenosis in any major vessel and preserved left ventricular function. All patients were followed up for a median of 7.1 years (first quartile 5 and third quartile 10.5). Dipyridamole echocardiography test (DET) positivity for regional dysfunction occurred in 43(9%) patients. Kaplan-Meier survival estimates showed a significant better outcome for those patients with negative dipyridamole echocardiography test compared with those with a positive test (90 vs. 75.7%, at 140 months of follow-up, P = 0.0018). At multivariable analysis, mild or moderate irregularity on coronary arteriogram (HR = 3.3, CI 95% = 1.7-6.2), diabetes (HR = 3.5, CI 95% = 1.4-9.2), and wall motion score index at peak stress (HR = 6.7, CI 95% = 2.5-17.8) were independent predictors of all-cause death.

Conclusion DET adds incremental value to the prognostic stratification achieved with clinical and angiographic data in the subset of patients with normal or near-normal coronary arteries.

Keywords: Dipyridamole echocardiography test (DET); Prognosis; Normal coronary artery.
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