title: [Aspects of risk stratification in acute coronary syndrome (Part II): Prognostic value of evaluation of exercise-induced myocardial ischemia according to the data of pharmacological stress echocardiography].
abstract: OBJECTIVE
  To define the prognostic value of evaluation exercise-induced myocardial ischemia according to the data of pharmacological (dobutamine or dipyridamole) stress echocardiography (EchoCG) in patients with acute coronary syndrome (ACS).
  
  
  METHODS
  The results of examinations were analyzed in a total of 91 patients with ACS. An analysis of events in the established follow-up period (mean 14.3 +/- 0.7 months) took into consideration outcomes, such as death from cardiac diseases, a recurrent acute coronary episode (nonfatal myocardial infarction (MI), unstable angina (UA).
  
  
  RESULTS
  Pharmacological stress EchoCG showed a positive result in 40 (44%) patients (Group 1) and a negative one in 51 (56%) patients (Group 2). Thus, the sensitivity and specificity of the pharmacological test in determining the risk for cardiac events were 89.3 and 76.2%, respectively; the prognostic value of positive and negative results was 62.5 and 94.1%, respectively. Analysis of EchoCG parameters used to identify poor prognostic factors in patients with ACS has indicated that the most important predictors of death and major cardiac events (cardiac death, acute MI, UA) are resting impaired segmental contractility index (ISCI), number of asynergic segments, and total ejection fraction (TEF) at baseline; TEF, ISCI, deltaISCI (as compared to the baseline data), and the number of segments with a negative response after low-dose drug infusion; a positive or negative result, TEF, deltaTEF (as compared to the baseline data), and ISCL at the test peak.
  
  
  CONCLUSIONS
  Pharmacological stress EchoCG is a safe noninvasive diagnostic method in a group of patients with ACS. When the latter is diagnosed, it may be performed in the earliest periods (on day 4 after onset of the disease) to estimate its prognosis and to decide whether aggressive treatments should be used.
authors.forename: V A
authors.initials: VA
authors.lastname: Gukasian
authors.forename: S T
authors.initials: ST
authors.lastname: Matskeplishvili
authors.forename: V I
authors.initials: VI
authors.lastname: Ioshina
authors.forename: M A
authors.initials: MA
authors.lastname: Aripov
authors.forename: L S
authors.initials: LS
authors.lastname: Shakhnazarian
authors.forename: É U
authors.initials: ÉU
authors.lastname: Asymbekova
authors.forename: E V
authors.initials: EV
authors.lastname: Zhertovskaia
authors.forename: Iu I
authors.initials: IuI
authors.lastname: Buziashvili
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis / Q000401:mortality; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis