TAILIEUCHUNG - Prognostic Significance of Dyspnea in Patients Referred for Cardiac Stress Testing

Although dyspnea is a common symptom, there has been only limited investigation of its prognostic significance among patients referred for cardiac evaluation. methods We studied 17,991 patients undergoing myocardial-perfusion single-photon-emission computed tomography during stress and at rest. Patients were divided into five categories on the basis of symptoms at presentation (none, nonanginal chest pain, atypical angina, typical angina, and dyspnea). Multivariable analysis was used to assess the incremental prognostic value of symptom categories in predicting the risk of death from cardiac causes and from any cause. In addition, the prognosis associated with various symptoms at presentation was compared in subgroups selected on the basis of propensity analysis | Prognostic Significance of Dyspnea in Patients Referred for Cardiac Stress Testing Prognostic Significance of Dyspnea in Patients Referred for Cardiac Stress Testing Aiden Abidov . . Alan Rozanski . Rory Hachamovitch . Sean W. Hayes . Fatma Aboul-Enein . Ishac Cohen . John D. Friedman . Guido Germano . and Daniel S. Berman . abstract background Although dyspnea is a common symptom there has been only limited investigation of its prognostic significance among patients referred for cardiac evaluation. methods We studied 17 991 patients undergoing myocardial-perfusion single-photon-emission computed tomography during stress and at rest. Patients were divided into five categories on the basis ofsymptoms at presentation none nonanginal chest pain atypical angina typical angina and dyspnea . Multivariable analysis was used to assess the incremental prognostic value of symptom categories in predicting the risk of death from cardiac causes and from any cause. In addition the prognosis associated with various symptoms at presentation was compared in subgroups selected on the basis of propensity analysis. results After a mean SD follow-up of years the rate of death from cardiac causes and from any cause was significantly higher among patients with dyspnea both those previously known to have coronary artery disease and those with no known history of coronary artery disease than among patients with other or no symptoms at presentation. Among patients with no known history ofcoronary artery disease those with dyspnea had four times the risk of sudden death from cardiac causes of asymptomatic patients and more than twice the risk of patients with typical angina. Dyspnea was associated with a significant increase in the risk of death among each clinically relevant subgroup and remained an independent predictor of the risk ofdeath from cardiac causes P and from any cause P after adjustment for other significant factors by .

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