The Experts below are selected from a list of 255 Experts worldwide ranked by ideXlab platform

Paolo M Fioretti - One of the best experts on this subject based on the ideXlab platform.

Riccardo Bigi - One of the best experts on this subject based on the ideXlab platform.

  • diagnostic value of Exercise Electrocardiography and dipyridamole stress echocardiography in hypertensive and normotensive chest pain patients with right bundle branch block
    Journal of Hypertension, 2003
    Co-Authors: Lauro Cortigiani, Riccardo Bigi, Fausto Rigo, Patrizia Landi, Umberto Baldini, Pier Romano Mariani, Eugenio Picano
    Abstract:

    OBJECTIVES: Studies on the diagnostic value of Exercise Electrocardiography in right bundle branch block produced controversial results, and data on the accuracy of stress echo are still lacking. The aim of the study was to compare the diagnostic value of Exercise Electrocardiography and dipyridamole stress echo in chest pain patients with right bundle branch block, and to verify whether stress testing accuracy is affected by history of hypertension. METHODS: The study group was made up of 71 patients (56 men, aged 63 +/- 8 years) with chest pain of unknown origin and complete right bundle branch block. Of them, 35 were hypertensives and 36 normotensives. Patients performed, on different days and in random order, Exercise Electrocardiography and dipyridamole stress echo and underwent coronary angiography. RESULTS: Significant (> or = 70% diameter stenosis) coronary artery disease was found in 34 patients (17 hypertensives and 17 normotensives). Positive Exercise Electrocardiography (ST-segment shift > 1 mm at 80 ms after the J point in leads V5 and V6 or leads II and Vf) and dipyridamole stress echo (new wall motion abnormalities) were observed in 38 and 30 patients, respectively. The result of tests was concordant in 69% of hypertensives and 92% of normotensives. The two tests shared the same sensitivity in hypertensives (82%) and normotensives (71%). Of 37 patients without coronary artery disease, 12 had a false-positive result during Exercise Electrocardiography and four during stress echo. The specificity was lower for Exercise Electrocardiography than for stress echo in hypertensives (50 versus 89%, P = 0.0006), while no difference was evidenced in normotensives (84 versus 89%, P = 0.4). In hypertensives, the accuracy, positive, and negative predictive values were 66, 61, and 75% for Exercise Electrocardiography, and 86, 87, and 84% for stress echo. Corresponding figures in normotensives were 78, 80, and 76% for Exercise Electrocardiography, and 81, 86, and 77% for stress echo. CONCLUSIONS: In chest-pain patients with right bundle branch block, dipyridamole stress echo was effective to diagnose coronary artery disease in both normotensives and hypertensives. Moreover, it exhibited superior diagnostic information than Exercise Electrocardiography in hypertensives, due to significantly higher specificity. However, the two tests had similar diagnostic value in normotensives.

  • Exercise Electrocardiography after acute coronary syndromes: still the first testing modality?
    Clinical Cardiology, 2003
    Co-Authors: J. Willis Hurst, Lauro Cortigiani, Riccardo Bigi, Alessandro Desideri
    Abstract:

    Recent diagnostic and therapeutic advances have been questioning the role of Exercise Electrocardiography (ECG) for risk stratification of patients recovering from an acute coronary syndrome. The aim of this review was to verify whether evidence still exists supporting the use of Exercise ECG as first choice stress testing modality in this clinical setting in the light of the most recent prognostic data and of cost effectiveness considerations. It was concluded that a large body of evidence supports the use of Exercise ECG as a cost-effective tool for prognostic purposes and for quality of life assessment following acute coronary syndromes.

  • incremental prognostic value of stress echocardiography as an adjunct to Exercise Electrocardiography after uncomplicated myocardial infarction
    Heart, 2001
    Co-Authors: Riccardo Bigi, Alessandro Desideri, C Coletta, Cesare Fiorentini, Alfonso Galati, Paolo M Fioretti
    Abstract:

    Objective—To assess the prognostic value of stress echocardiography as an adjunct to Exercise Electrocardiography in patients with uncomplicated acute myocardial infarction. Design—496 patients underwent a maximum Exercise ECG and pharmacological stress echocardiography (406 dobutamine and 90 dipyridamole) within 15 days of uncomplicated acute myocardial infarction and were followed for a mean of 25 months (range 1‐74 months) for reinfarction, unstable angina, and cardiac death. Patients undergoing revascularisation were omitted. Results—Exercise ECG was positive in 162 patients (32.6%) and low threshold positive ( 100 W) positive Exercise ECG. Eventfree survival of patients with both tests positive was significantly less than in patients with only one positive test or with both tests negative. Conclusions—Stress echocardiography provides additional prognostic information after uncomplicated acute myocardial infarction, but the greatest gain is found in patients with a high threshold positive Exercise ECG. (Heart 2001;85:417‐423)

  • stress echocardiography and Exercise Electrocardiography for risk stratification after non q wave uncomplicated myocardial infarction
    American Journal of Cardiology, 1999
    Co-Authors: Alessandro Desideri, Riccardo Bigi, Gian Leone Suzzi, C Coletta, Dario Gregori, Gino Valente, Paolo M Fioretti
    Abstract:

    : The aim of our study was to compare the prognostic value of stress echocardiography and Exercise Electrocardiography after uncomplicated non-Q-wave acute myocardial infarction in a series of 68 consecutive patients. Our data show that stress echocardiography and Exercise Electrocardiography offer similar prognostic information after uncomplicated non-Q-wave AMI.

  • Different Clinical and Prognostic Significance of Painful and Silent Myocardial Ischemia Detected by Exercise Electrocardiography and Dobutamine Stress Echocardiography After Uncomplicated Myocardial Infarction
    American Journal of Cardiology, 1998
    Co-Authors: Riccardo Bigi, C Coletta, Galati A, Gianpiero Curti, Roberto Ricci, Federico Fedeli, G. Occhi, Vincenzo Ceci, Cesare Fiorentini
    Abstract:

    : Prevalence and prognostic significance of painful and silent ischemia detected by Exercise Electrocardiography (ECG) and dobutamine stress echocardiography (DSE) were evaluated in 407 consecutive patients recovering from acute myocardial infarction. Painful ischemia assessed by both tests was not associated with different clinical characteristics of patients; on the other hand, it identified a higher risk subgroup compared with silent ischemia during Exercise ECG but not during DSE.

Edward D Folland - One of the best experts on this subject based on the ideXlab platform.

  • evaluation of Exercise thallium scintigraphy versus Exercise Electrocardiography in predicting survival outcomes and morbid cardiac events in patients with single and double vessel disease findings from the angioplasty compared to medicine acme study
    Journal of the American College of Cardiology, 1997
    Co-Authors: Alfred F Parisi, Pamela M Hartigan, Edward D Folland
    Abstract:

    Abstract Objectives. We sought to evaluate the prognostic ability of cardiac Exercise stress tests in predicting cardiac mortality and morbidity in a low risk group of patients with established coronary artery disease (CAD). Background. Although previous studies have demonstrated the superior value of stress nuclear cardiac scintigraphy in the prognosis of patients with CAD, none of these studies have focused on patients with a proven angiographic low risk profile (i.e., single- and double-vessel CAD). Methods. Three hundred twenty-eight patients with documented single- and double-vessel disease were treated by random assignment to percutaneous transluminal coronary angioplasty or medical therapy in the Angioplasty Compared to Medicine (ACME) trial. Six months after randomization, maximal symptom-limited Exercise tests were performed with Electrocardiography (n = 300) and thallium scintigraphy (n = 270). Patients were followed up for a minimum of 5 years thereafter. Results. A reversible thallium perfusion deficit documented after 6 months of either therapy was associated with an adverse mortality outcome (18% mortality rate with a reversible thallium perfusion defect and 8% mortality rate with no reversible thallium perfusion deficit, p = 0.02). Moreover, an important mortality gradient was demonstrated in relation to the number of reperfusing defects (0 = 7%, 1 to 2 = 15%, >3 = 20%, p = 0.04). Exercise Electrocardiography did not predict this mortality outcome. Conclusions. A reversible thallium perfusion deficit demonstrated 6 months after medical therapy or coronary angioplasty is a valuable prognostic marker in patients with angiographically documented single- and double-vessel disease and is superior to Exercise Electrocardiography in this regard.

J T Takkunen - One of the best experts on this subject based on the ideXlab platform.

  • evaluation of Exercise Electrocardiography and thallium tomographic imaging in detecting asymptomatic coronary artery disease in diabetic patients
    Heart, 1990
    Co-Authors: M J Koistinen, Heikki V Huikuri, H Pirttiaho, Markku K Linnaluoto, J T Takkunen
    Abstract:

    Thallium tomographic imaging and Exercise Electrocardiography were performed on 136 diabetic patients without symptoms of heart disease. Thirty three patients had post-Exercise thallium defects and 19 had ST 1 mm greater than or equal to segment depression during Exercise Electrocardiography. Both tests were positive in 13 patients. Coronary angiography was subsequently performed on 33 patients with either scintigraphic and/or electrocardiographic evidence of myocardial ischaemia. Angiographically significant coronary artery disease (greater than or equal to 50% narrowing of the coronary artery lumen) was detected in 13 patients. Six patients had minimal coronary artery stenosis (less than 50%), and 14 had normal coronary arteries. Six patients refused cardiac catheterisation. In 14 out of 27 patients with post-Exercise thallium defects coronary angiography did not show any coronary artery stenoses (positive predictive accuracy 48%). Exercise Electrocardiography showed only one false positive result (positive predictive accuracy 94%) but failed to detect coronary artery disease in three patients with a positive scintigraphic result. The accuracy of a positive Exercise electrocardiographic test seems to be better than that of a positive thallium tomographic scan for detecting asymptomatic coronary artery disease in diabetic patients. The high number of false positive thallium defects may be the result of technical features inherent in thallium tomography and/or the possible disease of the small intramyocardial arteries in diabetic patients.

Alessandro Desideri - One of the best experts on this subject based on the ideXlab platform.