The reported incidence of atrial fibrillation (AF) occurring during dobutamine stress echocardiography (DSE) ranges from 0.5% to 4%. The aim of this study was to characterize the incidence, risk ...factors, and outcomes of AF precipitated during DSE.
The clinical and echocardiographic data of consecutive patients over a 50-month period who were in sinus rhythm and underwent DSE were retrospectively reviewed.
A total of 11,806 consecutive patients underwent DSE and met all inclusion criteria. AF developed during DSE in 122 patients (1%), 71 of whom had histories of AF. The duration of AF was <1 hour in 74 patients (61%) and<24 hours in 117 patients (96%). Of the 47 patients who were still in AF when dismissed from the echocardiography laboratory, 21 had outpatient follow-up within 24 hours, eight were already inpatients, and 18 were triaged to the emergency department or hospital. Spontaneous cardioversion occurred in 114 patients (93%). There were no reported complications. The clinical characteristic most strongly associated with the development of AF during DSE was a history of AF (odds ratio, 18.4 if no history of congestive heart failure; P<.001). The presence or extent of stress-induced myocardial ischemia was not predictive of the development of AF.
AF is an infrequent complication of DSE. Most patients return to sinus rhythm spontaneously within 1 hour. Patients with persistent AF can be safely dismissed from the echocardiography laboratory to have outpatient follow-up within 24 hours unless they have suboptimal heart rate control, hypotension, significant symptoms, or markedly abnormal findings on DSE.
The aim of this study was to investigate the incidence and predictors of neuropsychiatric (NP) symptoms during 24 hours after dobutamine-atropine stress testing (DST).
Consecutive outpatients ...undergoing DST were asked to return a questionnaire regarding symptoms during the following 24 hours. Trained registered nurses administered the Delirium Observation Screening Scale before and after DST. To assess baseline symptoms in a control group, consecutive patients referred for DST completed the questionnaire regarding their symptoms during the 24 hours before DST.
A total of 1,006 patients were included (mean age, 67 ± 12 years; 462 46% women). Of the 750 patients who returned questionnaires, 53 patients (7.1%) reported NP symptoms. Among the 199 controls, three patients (1.5%) reported NP symptoms. Symptoms were usually mild and resolved spontaneously. Independent predictors of NP symptoms were atropine dose ≥ 1 mg (odds ratio OR, 7.69; 95% confidence interval CI, 4.13-14.81), prior NP disorder (OR, 2.11; 95% CI, 1.11-4.02), positive Delirium Observation Screening Scale result (OR, 4.89; 95% CI, 1.21-18.09), and body mass index < 24 kg/m(2) (OR, 2.37; 95% CI, 1.10-4.90).
Although usually mild, NP symptoms were nearly fivefold more common after DST (P < .001). Patients who had received ≥ 1 mg atropine and those with underlying NP disease, positive Delirium Observation Screening Scale results, or lower body mass indexes are at increased risk.
The aim of this study was to evaluate published appropriateness criteria for CT angiography (CTA) at the authors' academic medical center.
Two observers independently reviewed the medical records of ...251 patients who had undergone dual-source coronary CTA from June 1 to December 31, 2007. Patients were assigned to indications from 1 of 7 tables from the American College of Cardiology Foundation and ACR Appropriateness Criteria. Agreement between the two observers was assessed using kappa statistics. Disagreements were resolved by consensus panel. The final numbers of appropriate, uncertain, inappropriate, and not classifiable indications were recorded.
Indications for testing were classified as appropriate in 69 patients (27%), inappropriate in 42 patients (17%), and uncertain in 25 patients (10%). One hundred fifteen indications for coronary CTA (46%) were not classifiable. Analysis of interobserver variability for overall appropriateness yielded a kappa value of 0.31, which was considered to indicate fair agreement.
The results of this study suggest that a significant proportion (46%) of the coronary CTA studies performed at the authors' institution are for indications that are not covered by the published appropriateness criteria. Modifications to these criteria could help decrease the number of studies that are not classifiable. Physician education could decrease the number of inappropriate studies.
Stress Echocardiography Pellikka, Patricia A., MD, FACC; McCully, Robert B., MD, FACC
Journal of the American College of Cardiology,
11/2007, Volume:
50, Issue:
20
Journal Article
Peer reviewed
Open access
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Objectives We evaluated the short- and long-term safety of contrast agents during stress echocardiography (SE). Background Concerns about contrast agent safety led to revised recommendations for ...product use in the U.S. Methods We studied 26,774 patients who underwent SE between November 1, 2003, and December 31, 2007. The 10,792 patients who comprised the contrast cohort received second-generation perfluorocarbon-based agents for left ventricular opacification during SE. The noncontrast cohort comprised 15,982 patients who had their first SE in the same period but without contrast agents. Short-term (≤72 h and ≤30 days) and long-term (up to 4.5 years) end points were death and myocardial infarction (MI). Cox regression models were used. Immediate contrast agent-related adverse effects were also reported. Results The contrast cohort had older patients (mean SD age, 65.8 12.1 years vs. 62.6 14.1 years; p < 0.001), a higher percentage of males (57.4% vs. 52.8%, p < 0.001), and higher-risk patients compared with the noncontrast cohort. In addition, dobutamine SE patients had greater cardiac risk than exercise SE patients. Abnormal SE findings in patients who received contrast agents were more frequent (32.4% vs. 27.9%, p < 0.001). The 2 cohorts had no statistical difference in the incidence of short-term events (death and MI). Within 72 h, 1 patient in the contrast cohort and 2 patients in the noncontrast cohort died (p = 0.54); 3 in the contrast cohort and 7 in the noncontrast cohort had MI (p = 0.92). Within 30 days, 37 patients (0.34%) in the contrast cohort and 57 patients (0.36%) in the noncontrast cohort died (p = 0.85); 17 patients (0.16%) in the contrast cohort and 16 patients (0.10%) in the noncontrast cohort had MI (p = 0.19). Adjusted hazard ratios were not different between cohorts for death (0.99; 95% confidence interval: 0.88 to 1.11) or MI (0.99; 95% confidence interval: 0.80 to 1.22). Conclusions The use of contrast agents during SE was not associated with an increased short-term or long-term risk of death or MI.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Abstract Background Antiplatelet (AP) medication use is common among trauma patients and is associated with poor outcomes. Management options for platelet dysfunction in trauma patients are ...controversial, expensive and potentially harmful. Although light transmission platelet aggregometry is considered the standard test to assess platelet function, it is cumbersome and not generally available. Currently, there are no widely accepted platelet function point-of-care tests for acute trauma. Study Design Prospective observational study from 2014–2015. Baseline Multiplate aggregometry aspirin area under the platelet aggregation curve (ASPI AUC), TEG platelet mapping percent inhibition of arachidonic acid (TEG-PM AA), and VerifyNow Aspirin Test (ARU) were compared for ability to detect any AP medication use (aspirin or clopidogrel), platelet dysfunction, and identify patients at risk for intracranial hemorrhage (ICH) progression by calculating the area under receiver operating characteristic curves (AUC), sensitivity, specificity, and positive and negative predictive values. Adenosine Diphosphate (ADP) assays were similarly evaluated. Results 64 patients were enrolled, 25 were taking AP medications. AP patients were older (71.6 v 35.0 years, p <0.001), and received more platelet transfusions, but other baseline characteristics were similar. Median ASPI AUC (22.0 v 53.5 p <0.001) and VerifyNow ARU (503.5 v 629.0, p <0.001) were lower, while TEG-PM AA (51.8% v 18.3%, p <0.001) was higher in AP patients. Multiplate ASPI AUC, TEG-PM AA percent inhibition and VerifyNow ARU could identify AP medication use (AUC 0.90, 0.77, 0.90 respectively). ADP assays did not correlate with AP medication use in this population. TEG-PM AA percent inhibition and VerifyNow ARU correlated well with Multiplate ASPI AUC to identify platelet dysfunction (AUC 0.78, 0.89 respectively). ICH occurred in 29 patients, 12 of which had progression of their injury. ASPI AUC (AUC 0.50) and Verifynow ARU (AUC 0.59) did not correlate,, and TEG-PM AA percent inhibition (AUC 0.66) minimally correlated with progression. Conclusions Multiplate, TEG-PM and VerifyNow are useful point-of-care tests which identify AP medication use and platelet dysfunction in trauma patients. Initial TEG-PM AA percent inhibition may be associated with risk for ICH progression. However, additional large, prospective studies are needed.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
The mechanisms for abnormal stress echocardiograms (SEs) in patients with normal coronary arteries have not been clearly elucidated. We hypothesized that in some patients, this phenomenon may ...represent a forme fruste of apical ballooning syndrome (ABS). The aim of the study was to evaluate the characteristics of patients with strongly false-positive SEs and determine whether there were similarities to ABS. Thirty-one patients from the Mayo Clinic stress echocardiography database who had normal function at rest, extensive regional wall motion abnormalities in association with an abnormal response of left ventricular end-systolic cavity size at peak stress, and angiographically normal coronary arteries were evaluated. Eighty-four percent were women with a mean age of 61 ± 12 years, 6% had a positive stress electrocardiogram, and only 26% had a hypertensive response to stress. In 81%, left ventricular ejection fraction decreased with stress and 97% developed new regional wall motion abnormalities in ≥4 segments. Peak wall motion score index was 1.65 ± 0.39. Midventricular (100%) and apical (87%) segments were most often involved with relative sparing of the basal segments (77%; p = 0.01). There were no deaths during follow-up (2.3 ± 0.7 years). In conclusion, the major findings of this study were that strongly false-positive SEs occurred predominantly in postmenopausal women, and frequently involved the apical and mid–left ventricular segments, features that were similar to ABS. Data were consistent with the hypothesis that some false-positive SEs may represent a forme fruste of ABS.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
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