Prognostic Significance of Dyspnea in Patients Referred for Cardiac Stress Testing

• Published in: The New England journal of medicine Vol. 353; no. 18; pp. 1889 - 1898
• Main Authors: Abidov, Aiden, Rozanski, Alan, Hachamovitch, Rory, Hayes, Sean W, Aboul-Enein, Fatma, Cohen, Ishac, Friedman, John D, Germano, Guido, Berman, Daniel S
• Format: Journal Article
• Language: English
• Published: United States Massachusetts Medical Society 03.11.2005
• Subjects: Aged; Angina pectoris; Angina Pectoris - complications; Angina Pectoris - mortality; Cardiovascular disease; Coronary Disease - complications; Coronary Disease - diagnosis; Diagnostic tests; Dyspnea - etiology; Dyspnea - mortality; Exercise Test; Female; Follow-Up Studies; Heart Diseases - complications; Heart Diseases - diagnosis; Heart Diseases - mortality; Humans; Male; Medical diagnosis; Middle Aged; Mortality; Prognosis; Risk Factors; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa042741

Dyspnea is a common symptom of cardiac and noncardiac disorders, but its prognostic significance has not been extensively evaluated. In a study of nearly 18,000 patients undergoing stress and resting myocardial-perfusion imaging, those presenting with dyspnea had more than twice the risk of death from cardiac causes or from any cause of those presenting with typical angina. In a study of nearly 18,000 patients undergoing stress and resting myocardial-perfusion imaging, those presenting with dyspnea had more than twice the risk of death from cardiac causes or from any cause of those presenting with typical angina. A number of clinical variables have been used to assess prognosis in patients with known or suspected coronary artery disease, including age, sex, coronary risk factors, and the presence or absence and character of chest pain. 1 , 2 Although other somatic symptoms may also be associated with coronary artery disease, including fatigue, dyspnea, and palpitations, they have not been routinely integrated into models predicting the risk of cardiac events. Among commonly cited symptoms, dyspnea is of particular interest, since it may be a sign of occult left ventricular dysfunction or noncardiac disease (especially pulmonary disorders such as chronic bronchitis or emphysema) . . .