RESUMO
Objetivo: Avaliar o significado da evidência da isquemia miocárdica e a ocorrência de eventos cardiovasculares na Síndrome Cardíca X (SCX), comparando com doença coronária obstrutiva inicial (DAC <- 50 por cento). Métodos: Estudo observacional de coorte, em, amostra de 605 pacientes (população fonte de 5.137 indivíduos), com ecocardiografia sob estresse físico (EEF) positiva para isquemia miocárdica, os quais foram submetidos à cineangiocoronariografia, e divididos, posteriormente, em 2 grupos: G1 (SCX, n=64) e G2 (DAC<- 50 por cento, n=84). Os pacientes foram comparados quanto às características clínicas, parâmetros ergométricos e ecocardiográficos, e seguidos po +- 43,8 meses (mínimo de 12 meses e máximo de 85 meses), quanto ao surgimento de ngina típica, infarto agudo do miocárdico...
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Angina Microvascular/complicações , Angina Microvascular/diagnóstico , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico , Ecocardiografia sob Estresse/métodos , Ecocardiografia sob Estresse , Isquemia Miocárdica/diagnóstico , Fatores de RiscoRESUMO
BACKGROUND: Exercise echocardiography (EE) is an established method to diagnose coronary artery disease (CAD). Chronotropic incompetence (CI) during the EE may be a marker of myocardial ischemia. The purpose of this investigation was to evaluate the additive value of CI during EE in CAD diagnosis. METHODS: Between 2000 and 2006, 4042 patients (1900 men with a mean age of 56 +/- 11 years) were evaluated by EE. Based on the heart rate (HR) reached during the exercise test, the subjects were divided into two groups: G1 group - 490 patients who failed to achieve 85% of the maximal age-predicted HR, and G2 group - 3552 patients who were able to achieve 85% of the maximal age-predicted HR. Clinical characteristics, left ventricular wall motion abnormalities - wall motion score index (WMSI) - and coronary angiography (CA) were the parameters compared between the two groups. RESULTS: The left ventricular wall motion abnormalities were more frequent in G1 group than in G2 group (54% versus 26%; P < 0.00001). WMSI was higher in G1 group than in G2 group, both at rest (1.06 +/- 0.17 versus 1.02 +/- 0.09; P < 0.0001) and after exercise (1.12 +/- 0.23 versus 1.04 +/- 0.21; P < 0.0001). In G1 group, 82% of the patients with positive EE for myocardial ischemia presented obstructive coronary, compared to 71% (P = 0.03) in G2 group. CONCLUSION: CI is associated with a higher frequency of myocardial ischemia during EE, reinforcing the concept that CI is a marker of the severity of myocardial ischemia.
