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Non-Invasive Tests Can Predict Clinical Outcome In Stable Angina
A DGReview of :"The value of routine non-invasive tests to predict clinical outcome in stable angina"
European Heart Journal
03/26/2003
By Harvey McConnell
A simple non-invasive combination method including electro- and echocardiograms, along with exercise testing, appears to predict two year probability of events in stable angina.
Dr C Daly and colleagues at the Royal Brompton Hospital, London, England, to assess the value of routine non-invasive tests in a cohort of 682 patients who were part of the Total Ischaemic Burden European Trial (TIBET) study.
Patients with chronic stable angina are commonplace, the clinicians point out. However, there are considerable differences of views about the probability of acute coronary events, such as coronary heart disease death, non-fatal myocardial infarction (MI) and unstable angina between individual patients. There is a need for clinicians to be able to make effective predictions in order to devise the optimum management for the patient.
The study cohort underwent exercise testing (1 mm ST depression). While not taking any anti-anginal medication, a resting ECG, exercise tolerance testing, and echocardiography were performed at baseline. The patients were then randomised to treatment with atenolol, nifedipine or a combination of both.
Clinical follow up continued for an average of two years, with a range of one to three years.
Results show that among the cohort a prior MI, or prior CABG, were the clinical parameters which were associated with adverse outcome among patients with stable angina and a positive exercise test.
From the ECG, left ventricular hypertrophy was predictive. From the echocardiogram, increased left ventricular dimensions were predictive of adverse events. "When combined with time to ischaemia on exercise testing in a simple clinically applicable table these factors could be used to predict of two year probability of events for an individual patient," the clinicians conclude.
Eur Heart J 2003 Mar;24:6:532-40.
"The value of routine non-invasive tests to predict clinical outcome in stable angina"
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