Skip to main content

Special Subsets of Angiographically Defined Patients: Normal Coronary Arteries, Single-Vessel Disease, Left Main Coronary Artery Disease, Major Noncardiac Vascular Surgery, Patients Undergoing Coronary Revascularization

  • Chapter
  • 87 Accesses

Abstract

In patients undergoing coronary angiography for investigation of chest pain, the incidence of normal or near-normal coronary arteriographic findings varies between 10% and 20% [1]. In general, patients without significant epicardial coronary artery disease have an excellent prognosis, but not all nonsignificant stenosis are created prognosti-cally equal, since coronary events are rare in patients with smooth, normal arteriograms, sixfold more frequent in patients with mild (o%-20% stenosis), and 15-fold more frequent in patients with moderate (20%-40%, and still nonsignificant) lesions [2].

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   74.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Schwartz L, Bourassa MG (2001) Evaluation of patients with chest pain and normal coronary angiograms. Arch Intern Med 161:1825–1833

    Article  PubMed  CAS  Google Scholar 

  2. Proudfit WL, Albert VG, Bruschke MD, et al (1980) Clinical course of patients with normal or slightly or moderately abnormal coronary angiograms: 10-year follow-up of 521 patients Circulation 62:712–717

    Article  PubMed  CAS  Google Scholar 

  3. Bigi R, Cortigiani L, Bax JJ et al (2002) Stress echocardiography for risk stratification of patients with chest pain and normal or slightly narrowed coronary arteries. J Am Soc Echocardiogr 15:1285–9

    Article  PubMed  Google Scholar 

  4. Zeiher AM, Krause T, Schachinger V, et al (1995) Impaired endothelium-dependent vasodilation of coronary resistance vessels is associated with exercise-induced myocardial ischemia. Circulation 91:2345–2352

    Article  PubMed  CAS  Google Scholar 

  5. Picano E, Palinkas A, Amyot R (2001) Diagnosis of myocardial ischemia in hypertensive patients. J Hypert 19:1177–1183

    Article  CAS  Google Scholar 

  6. Parisi AF, Folland ED, Hartigan P (1992) A comparison of angioplasty with medical therapy in the treatment of single-vessel coronary artery disease. N Engl J Med 326:10–16

    Article  PubMed  CAS  Google Scholar 

  7. Cortigiani L, Picano E, Landi P, et al on behalf of the Echo Persantine (EPIC) and Echo Dobutamine (EDIC) International Cooperative Study Groups (1998) Value of pharmacological stress echocardiography in risk stratification of patients with single-vessel disease: a report from the Echo-Persantine and Echo-Dobutamine International Cooperative studies. J Am Coll Cardiol 32:69–74

    Google Scholar 

  8. Topol EJ, Ellis SG, Cosgrowe D, et al (1993) Analysis of coronary angioplasty practice in the United States with an insurance-claims data base. Circulation 87:1489–1497

    Article  PubMed  CAS  Google Scholar 

  9. Smith SC Jr, Dove JT, Jacobs AK, et al; American Heart Association Task Force on Practice Guidelines. Committee to Revise the 1993 Guidelines for Percutaneous Transluminal Coronary Angioplasty (2001) ACC/AHA guidelines of percutaneous coronary interventions (revision of the 1993 PTCA guidelines) — executive summary. J Am Coll Cardiol 37:2215–2239

    Google Scholar 

  10. Andrade MJ, Picano E, Pingitore A, et al on behalf of the EPIC Study Group -Subproject “Left Main Detection” (1994) Dipyridamole stress echocardiography in patients with severe left main coronary artery narrowing. Am J Cardiol 73:450–455

    Google Scholar 

  11. Attenhofer CH, Pellikka PA, Oh JK, et al (1996) Comparison of ischemic response during exercise and dobutamine echocardiography in patients with left main coronary artery disease. J Am Coll Cardiol 27:1171–1177

    Article  PubMed  CAS  Google Scholar 

  12. Boersma E, Poldermans D, Bax JJ, et al; DECREASE Study Group (Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography) (2001) Predictors of cardiac events after major vascular surgery: role of clinical characteristics, dobutamine echocardiography, and beta-blocker therapy. JAMA 285:1865–1873

    Google Scholar 

  13. Shaw LJ, Eagle KA, Gersh BJ, et al (1996) Meta-analysis of intravenous dipyridamole-thallium-201 imaging (1985 to 1994) and dobutamine echocardiography (1991 to 1994) for risk stratification before vascular imaging. J Am Coll Cardiol 27:787–798

    Article  PubMed  CAS  Google Scholar 

  14. Tischler MD, Lee TH, Hirsch AT, et al (1991) Prediction of major cardiac events after peripheral vascular surgery using dipyridamole echocardiography. Am J Cardiol 68:593–597

    Article  PubMed  CAS  Google Scholar 

  15. Sicari R, Picano E, Lusa AM, et al on behalf of the EPIC Study Group — Subproject “Risk Stratification Before Major Vascular Surgery” (1995) The value of dipyridamole echocardiography in risk stratification before vascular surgery. A multicenter study. Eur Heart J 16:842–847

    PubMed  CAS  Google Scholar 

  16. Rossi E, Citterio F, Vescio MF, et al (1998) Risk stratification of patients undergoing peripheral vascular revascularization by combined resting and dipyridamole echocardiography. Am J Cardiol 82:306–310

    Article  PubMed  CAS  Google Scholar 

  17. Pasquet A, D’Hondt AM, Verhelst R, et al (1998) Comparison of dipyridamole stress echocardiography and perfusion scintigraphy for cardiac risk stratification in vascular surgery patients. Am J Cardiol 82:1468–1474

    Article  PubMed  CAS  Google Scholar 

  18. Sicari R, Ripoli A, Picano E, et al (1999) on behalf of the EPIC study group. Perioperative prognostic value of dipyridamole echocardiography in vascular surgery: a large-scale multicenter study on 509 patients. Circulation 100 [Suppl II]:269–274

    Google Scholar 

  19. Zamorano J, Duque A, Baquero M, et al (2002) Stress echocardiography in the pre-operative evaluation of patients undergoing major vascular surgery. Are results comparable with dipyridamole versus dobutamine stress echo? Rev Esp Cardiol 55:121–126

    PubMed  Google Scholar 

  20. Lane RT, Sawada SG, Segar DS, et al (1991) Dobutamine stress echocardiography for assessment of cardiac risk before noncardiac surgery. Am J Cardiol 68:976–977

    Article  PubMed  CAS  Google Scholar 

  21. Lalka SG, Sawada SG, Dalsing MC, et al (1992) Dobutamine stress echocardiography as a predictor of cardiac events associated with aortic surgery. J Vasc Surg 15:831–842

    Article  PubMed  CAS  Google Scholar 

  22. Davila-Roman VG, Waggoner AD, Sicard GA, et al (1993) Dobutamine stress echocardiography predicts surgical outcome in patients with an aortic aneurysm and peripheral vascular disease. J Am Coll Cardiol 21:957–963

    Article  PubMed  CAS  Google Scholar 

  23. Eichelberger JP, Schwarz KQ, Black ER, et al (1993) Predictive value of dobutamine echocardiography just before noncardiac vascular surgery. Am J Cardiol 72:602–607

    Article  PubMed  CAS  Google Scholar 

  24. Poldermans D, Fioretti PM, Forster T, et al (1993) Dobutamine stress echocardiography for assessment of perioperative cardiac risk in patients undergoing major vascular surgery. Circulation 87:1506–1512

    Article  PubMed  CAS  Google Scholar 

  25. Kertai MD, Boersma E, Sicari R et al (2002) Which stress test is superior for perioperative cardiac risk stratification in patients undergoing major vascular surgery? Eur J Vasc Endovasc Surg 24:222–9

    Article  PubMed  CAS  Google Scholar 

  26. Poldermans D, Arnese M, Fioretti PM, et al (1997) Sustained prognostic value of dobutamine stress echocardiography for late cardiac events after major noncardiac vascular surgery. Circulation 195:53–58

    Article  Google Scholar 

  27. Sicari R, Ripoli A, Picano E et al on behalf of the EPIC (Echo Persantine International Cooperative) Study Group (2002) Long-term prognostic value of dipyridamole echocardiography in vascular surgery: a large-scale multicenter study. Coron Artery Dis 13:49–55

    Google Scholar 

  28. Institute for Clinical Systems Improvement (2001) Cardiac Stress Test Supplement. http://www.ICI.org

  29. Schechter D, Bocher M, Berlatzky Y, et al (1994) Transient neurological events during dipyridamole stress test: an arterial steal phenomenon? J Nucl Med 35:1802–1804

    PubMed  CAS  Google Scholar 

  30. Molnar T, Zambo K, Schmidt E, et al (2000) Dipyridamole test in the early detection of cerebrovascular disorders? Orv Hetil 141:2717–2722

    PubMed  CAS  Google Scholar 

  31. Gruntzig AR, Senning A, Siegenthaler WE (1979) Nonoperative dilatation of coronary-artery stenosis: percutaneous transluminal coronary angioplasty. N Engl J Med 301:61–68

    Article  PubMed  CAS  Google Scholar 

  32. Sawada SG, Judson WE, Ryan T, et al (1989) Upright bicycle exercise echocardiography after coronary artery bypass grafting. Am J Cardiol 64:1123–1129

    Article  PubMed  CAS  Google Scholar 

  33. Biagini IA, Maffei S, Baroni M, et al (1990) Early assessment of coronary reserve after bypass surgery by dipyridamole transesophageal echocardiographic stress test. Am Heart J 120:1097–1101

    Article  PubMed  CAS  Google Scholar 

  34. Bongo AS, Bolognese L, Sarasso G, et al (1991) Early assessment of coronary artery bypass graft patency by high-dose dipyridamole echocardiography. Am J Cardiol 67:133–136

    Article  PubMed  CAS  Google Scholar 

  35. Crouse LJ, Vacek JL, Beauchamp GD, et al (1992) Exercise echocardiography after coronary artery bypass grafting. Am J Cardiol 70:572–576

    Article  PubMed  CAS  Google Scholar 

  36. Bjoernstad K, Aakhus S, Lundbom J, et al (1993) Digital dipyridamole stress echocardiography in silent ischemia after coronary artery bypass grafting and/or after healing of acute myocardial infarction. Am J Cardiol 72:640–646

    Article  PubMed  CAS  Google Scholar 

  37. Labovitz AJ, Lewen M, Kern MJ, et al (1989) The effects of successful PTCA on left ventricular function: assessment by exercise echocardiography. Am Heart J 117:1003–1008

    Article  PubMed  CAS  Google Scholar 

  38. Massa D, Pirelli S, Gara E, et al (1989) Exercise testing and dipyridamole echocardiography test before and 48 h after successful coronary angioplasty: prognostic implications. Eur Heart J 10 [Suppl G]:13–17

    Article  PubMed  Google Scholar 

  39. Picano E, Pirelli S, Marzilli M, et al (1989) Usefulness of high-dose dipyridamole echocardiography test in coronary angioplasty. Circulation 80:807–815

    Article  PubMed  CAS  Google Scholar 

  40. Broderick T, Sawada S, Armstrong WF, et al (1990) Improvement in rest and exercise-induced wall motion abnormalities after coronary angioplasty: an exercise echo cardiographic study. J Am Coll Cardiol 15:591–599

    Article  PubMed  CAS  Google Scholar 

  41. Aboul-Enein H, Bengston JR, Adams DB, et al (1991) Effect of the degree of effort on exercise echocardiography for the detection of restenosis after coronary artery angioplasty. Am Heart J 122:430–437

    Article  PubMed  CAS  Google Scholar 

  42. Pirelli S, Danzi GB, Alberti A, et al (1991) Comparison of usefulness of high-dose dipyridamole echocardiography and exercise electrocardiography for detection of asymptomatic restenosis after coronary angioplasty. Am J Cardiol 67:1335–1338

    Article  PubMed  CAS  Google Scholar 

  43. Pirelli S, Massa D, Faletra F, et al (1991) Exercise electrocardiography versus dipyridamole echocardiography testing in coronary angioplasty. Early functional evaluation and prediction of angina recurrence. Circulation 83 [Suppl III]:38–42

    Article  Google Scholar 

  44. McNeil AT, Fioretti PM, Al-Said SM, et al (1992) Dobutamine stress echocardiography before and after coronary angioplasty. Am J Cardiol 69:740–745

    Article  Google Scholar 

  45. Akosah KO, Porter TR, Simon R, et al (1993) Ischemia-induced regional wall motion abnormality is improved after coronary angioplasty: demonstration by dobutamine stress echocardiography. J Am Coll Cardiol 21:584–589

    Article  PubMed  CAS  Google Scholar 

  46. Mertes H, Erbel R, Nixdorff U, et al (1993) Exercise echocardiography for the evaluation of patients after nonsurgical coronary artery revascularization. J Am Coll Cardiol 21:1087–1093

    Article  PubMed  CAS  Google Scholar 

  47. Dagianti A, Rosanio S, Penco M et al (1997) Clinical and prognostic usefulness of supine bicycle exercise echocardiography in the functional evaluation of patients undergoing elective percutaneous transluminal coronary angioplasty. Circulation 95:1176–84

    Article  PubMed  CAS  Google Scholar 

  48. Pirelli S, Danzi GB, Massa D, et al (1993) Exercise thallium scintigraphy versus high-dose dipyridamole echocardiography testing for detection of asymptomatic restenosis in patients with positive exercise tests after coronary angioplasty. Am J Cardiol 71:1052–1056

    Article  PubMed  CAS  Google Scholar 

  49. Hecht HS, DeBord L, Shaw R, et al (1993) Usefulness of supine bicycle stress echocardiography for detection of restenosis after percutaneous transluminal coronary angioplasty. Am J Cardiol 71:293–296

    Article  PubMed  CAS  Google Scholar 

  50. Varga A, Picano E (1996) Evaluation of immediate and long-term results of intervention by echocardiography: can restenosis be predicted? Kluwer, Dordrecht, The Netherlands, pp387–399

    Google Scholar 

  51. Miller DD, Verani MS (1994) Current status of myocardial perfusion imaging after percutaneous transluminal coronary angioplasty. J Am Coll Cardiol 24:260–266

    Article  PubMed  CAS  Google Scholar 

Download references

Authors

Rights and permissions

Reprints and permissions

Copyright information

© 2003 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Picano, E., Sicari, R. (2003). Special Subsets of Angiographically Defined Patients: Normal Coronary Arteries, Single-Vessel Disease, Left Main Coronary Artery Disease, Major Noncardiac Vascular Surgery, Patients Undergoing Coronary Revascularization. In: Stress Echocardiography. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-05096-5_28

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-05096-5_28

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-05098-9

  • Online ISBN: 978-3-662-05096-5

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics