title: Prognostic value of pharmacological stress echocardiography is affected by concomitant antiischemic therapy at the time of testing.
abstract: BACKGROUND
  The aim of this study was to determine whether antianginal medications affect the prognostic value of pharmacological stress echocardiography.
  
  
  RESULTS
  From the EPIC-EDIC Data Bank, 7333 patients (5452 men; age; 59+/-10 years) underwent pharmacological stress echocardiography with either high-dose dipyridamole (0.84 mg/kg over 10 minutes; n=4984) or high-dose dobutamine (up to 40 microg x kg(-1) x min(-1); n=2349) (DET) for diagnostic purposes. At the time of testing, 1791 patients were on antiischemic therapy (nitrates and/or calcium antagonists and/or beta-blockers). Patients were followed up for a mean of 2.6 years (range, 1 to 206 months). DET was positive for myocardial ischemia in 2854 patients (39%) and negative in 4479 (61%). Total mortality was 336 (4.5%). Death was attributed to cardiac causes in 161 patients (2.1%). Survival was highest in patients with negative DET off therapy and lowest in patients with positive DET studied on therapy (95% versus 81%; P=0.0000). Survival was comparable in patients with a negative test on therapy and in patients with a positive test off therapy (88% versus 84%, P=NS).
  
  
  CONCLUSIONS
  Ongoing antiischemic therapy at the time of testing heavily modulates the prognostic value of pharmacological stress echo. In the presence of concomitant antiischemic therapy, a positive test is more prognostically malignant, and a negative test less prognostically benign.
authors.affiliation: CNR Institute of Clinical Physiology, Via G. Moruzzi, 1, 561200 Pisa, Italy. rosas@ifc.cnr.it
authors.forename: Rosa
authors.initials: R
authors.lastname: Sicari
authors.forename: Lauro
authors.initials: L
authors.lastname: Cortigiani
authors.forename: Riccardo
authors.initials: R
authors.lastname: Bigi
authors.forename: Patrizia
authors.initials: P
authors.lastname: Landi
authors.forename: Mauro
authors.initials: M
authors.lastname: Raciti
authors.forename: Eugenio
authors.initials: E
authors.lastname: Picano
mesh_terms: D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000401:mortality; D003951:Diagnostic Errors; D004176:Dipyridamole; D004280:Dobutamine; D025401:Echocardiography, Stress; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate
chemical_list: D004280:Dobutamine; D004176:Dipyridamole