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Rui Azevedo Guerreiro,Paula Fazendas,Ana Rita Pereira,Ana Marques,João Pais,Sofia Alegria,Kisa Hyde Congo,Ana Catarina Gomes,João Carvalho,Gonçalo Morgado,Inês Cruz,Ana Rita Almeida,Isabel João,Hélder 한국심초음파학회 2020 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.28 No.2
BACKGROUND: Stress echocardiography has a 72%–85% sensitivity and an 80%–95% specificity. In this study, we characterized patients who received a false-positive stress echocardiogram result. METHODS: A total of 5,256 patients underwent a stress echocardiogram (induced by exercise, dobutamine, or dipyridamole) between 2009 to 2018, and 405 patients (7.7%) received a positive result. Among the positive patients, 300 underwent coronary angiography within 12 months, and these patients were included in this study (mean age = 64.9 ± 9.4 years, 230 men [76.7%]). Coronary artery disease was diagnosed by stenosis ≥50% in any epicardial coronary artery. Clinical and echocardiographic variables were compared between patients with true- and false-positive stress echocardiogram results. RESULTS: Seventy-two patients (24%) had a false-positive stress echocardiogram, with similar rates across stressor types (p = 0.574). Patients with false positives were less frequently men (63.9% vs. 80.7%, p = 0.003), had lower diabetes mellitus prevalence (15.3% vs. 45.6%, p = 0.001), were similar to true positive patients with regard to body-mass index, arterial hypertension prevalence, hyperlipidemia and smoking, and had lower pre-test probability of coronary artery disease (23% vs. 32%, p = 0.016). The wall motion score index (WMSI) was higher in the true-positive stress group, and wall motion abnormalities were more frequent in the apical segments (70.5% vs. 56.7%, p = 0.034). In a multivariable predictive model, men (odds ratio [OR] = 2.994), diabetes (OR = 5.440), and peak WMSI (OR = 10.690) were associated with a true-positive result. CONCLUSIONS: Twenty-four percent of our study population received a false-positive stress echocardiogram result, with similar rates across stressor types. Patients with true-positive stress echocardiogram results are more likely to be men, diabetic, and have a high peak WMSI.
Endoscopy Timing in Patients with Acute Upper Gastrointestinal Bleeding
Gonçalo Alexandrino,Tiago Dias Domingues,Rita Carvalho,Mariana Nuno Costa,Luís Carvalho Lourenço,Jorge Reis 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.1
Background/Aims: The role of very early (≤12 hours) endoscopy in nonvariceal upper gastrointestinal bleeding is controversial. We aimed to compare results of very early and early (12–24 hours) endoscopy in patients with upper gastrointestinal bleedingdemonstrating low-risk versus high-risk features and nonvariceal versus variceal bleeding. Methods: This retrospective study included patients with nonvariceal and variceal upper gastrointestinal bleeding. The primaryoutcome was a composite of inpatient death, rebleeding, or need for surgery or intensive care unit admission. Endoscopy timing wasdefined as very early and early. We performed the analysis in two subgroups: (1) high-risk vs. low-risk patients and (2) variceal vs. nonvariceal bleeding. Results: A total of 102 patients were included, of whom 59.8% underwent urgent endoscopy. Patients who underwent very earlyendoscopy received endoscopic therapy more frequently (p=0.001), but there was no improvement in other clinical outcomes. Furthermore, patients at low risk and with nonvariceal bleeding who underwent very early endoscopy had a higher risk of thecomposite outcome. Conclusions: Very early endoscopy does not seem to be associated with improved clinical outcomes and may lead to poorer outcomesin specific populations with upper gastrointestinal bleeding. The actual benefit of very early endoscopy remains controversial andshould be further clarified.