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PubMed1998

The end of the Injury Severity Score (ISS) and the Trauma and Injury Severity Score (TRISS): ICISS, an International Classification of Diseases, ninth revision-based prediction tool, outperforms both ISS and TRISS as predictors of trauma patient survival, hospital charges, and hospital length of stay.

INTRODUCTION: Since their inception, the Injury Severity Score (ISS) and the Trauma and Injury Severity Score (TRISS) have been suggested as measures of the quality of trauma care. In concept, they are designed to accurately assess injury severity and predict expected outcomes. ICISS, an injury severity methodology based on International Classification of Diseases, Ninth Revision, codes, has been demonstrated to be superior to ISS and TRISS. The purpose of the present study was to compare the ability of TRISS to ICISS as predictors of survival and other outcomes of injury (hospital length of stay and hospital charges). It was our hypothesis that ICISS would outperform ISS and TRISS in each of these outcome predictions. METHODS: "Training" data for creation of ICISS predictions were obtained from a state hospital discharge data base. "Test" data were obtained from a state trauma registry. ISS, TRISS, and ICISS were compared as predictors of patient survival. They were also compared as indicators of resource utilization by assessing their ability to predict patient hospital length of stay and hospital charges. Finally, a neural network was trained on the ICISS values and applied to the test data set in an effort to further improve predictive power. The techniques were compared by comparing each patient's outcome as predicted by the model to the actual outcome. RESULTS: Seven thousand seven hundred five patients had complete data available for analysis. The ICISS was far more likely than ISS or TRISS to accurately predict every measure of outcome of injured patients tested, and the neural network further improved predictive power. CONCLUSION: In addition to predicting mortality, quality tools that can accurately predict resource utilization are necessary for effective trauma center quality-improvement programs. ICISS-derived predictions of survival, hospital charges, and hospital length of stay consistently outperformed those of ISS and TRISS. The neural network-augmented ICISS was even better. This and previous studies demonstrate that TRISS is a limited technique in predicting survival resource utilization. Because of the limitations of TRISS, it should be superseded by ICISS.

Adult↗
PubMed2004

Cerebral hypoxia in severely brain-injured patients is associated with admission Glasgow Coma Scale score, computed tomographic severity, cerebral perfusion pressure, and survival.

BACKGROUND: The purpose of this study was to determine the relationship of cerebral hypoxia with admission Glasgow Coma Scale (GCS) score, brain computed tomographic (CT) severity, cerebral perfusion pressure (CPP), and survival in patients with severe brain injury. METHODS: CPP and noninvasive transcranial oximetry (Stco2) were recorded hourly for 6 days in patients with a GCS score < or = 8 (3,722 observations). CT score was derived from midline shift (0/1) plus abnormal cisterns (0/1) plus subarachnoid hemorrhage (SAH) (0/1) (range, 0-3). RESULTS: Brain CT results were as follows: shift, 10 (56%); abnormal cisterns, 14 (78%); SAH, 9 (50%); epidural hematoma, 2 (11%); subdural hematoma, 11 (61%); and contusion, 17 (94%). The incidences of Stco2 < 60 were: GCS score 3-4, 26.5%; GCS score 5-7, 12.4%; and GCS score 8, 2.8% (p < 0.0001); CT score 2/3, 26.4%; and CT score 0/1, 10.0% (p < 0.0001); nonsurvivors 36.1%; and survivors 16.3% (p < 0.0001). For incidence of CPP < 70, the results were as follows: Stco2 < 60%, 33% of observations; Stco2 > or = 60%, 10% of observations (odds ratio, 4.3; p < 0.01). Despite CPP > or = 70, Stco2 < 60 incidence was 16% of observations. CONCLUSION: Cerebral hypoxia is common, even with CPP > or = 70, and is associated with GCS score, CT scan severity, and mortality. Cerebral hypoxia is related to cerebral hypoperfusion. Additional studies may prove that Stco2 monitoring will enhance the treatment of severe brain injury.

Adult↗
PubMed1987

Does the severity of presentation in children with vesicoureteric reflux relate to the severity of the disease or the need for operation?

The presenting symptoms, number of previous urinary tract infections, grade of reflux and incidence of renal scarring, together with an analysis of the need for reimplantation of the ureters, were assessed retrospectively in 222 patients with vesicoureteric reflux. The grade of reflux was found to be as severe in patients presenting after a single urinary tract infection as in those presenting after more than one infection. Regardless of whether patients presented with mild, moderate or severe symptoms, the degrees of reflux and renal scarring remained similar. There was no relationship between the severity of presenting symptoms and the eventual need for ureteric reimplantation. All children should be investigated when they present for the first time with a urinary tract infection, irrespective of age, sex or severity of symptoms.

Adolescent↗
PubMed2002

[The utility of the Pneumonia PORT prediction rule for evaluating the severity of community-acquired pneumonia in Japan. The relationship between disease severity and drug-resistant Streptococcus pneumoniae].

To examine the utility of the Pneumonia PORT prediction rule for evaluating the severity of community-acquired pneumonia (CAP) in Japan, 127 consecutive patients with CAP admitted during one-year period were recruited and stratified by the rule. The relationship between CAP severity determined by the rule and drug-resistant Streptococcus pneumoniae was also investigated. The number of the patients classified into each class was 20 (15.7%) in class I, 32 (25.2%) in class II, 32 (25.2%) in class III, 31 (24.4%) in class IV, and 12 (9.4%) in class V, respectively. Risk class-specific mortality rate was 0% in class I and II, 3.1% in class III, 3.2% in class IV, and 41.7% in class V, respectively. Twenty-seven patients (21.3%) were diagnosed as pneumococcal pneumonia. In terms of penicillin-susceptibility of Streptococcus pneumoniae, 19 strains (70.4%) were penicillin-susceptible Streptococcus pneumoniae (PSSP). Five (18.5%) were penicillin-intermediate Streptococcus pneumoniae (PISP), and 3 (11.1%) were penicillin-resistant Streptococcus pneumoniae (PRSP). Highly resistant pneumococci with penicillin MIC > or = 4.0 micrograms/mL was not observed. For severity of drug-resistant pneumococcal pneumonia, 3 patients infected with PISP were classified as class IV, 2 with PISP were as class V, 2 with PRSP were as class IV, and 1 with PRSP was as class V. The patients with drug-resistant pneumococcal pneumonia were classified as high risk classes (class IV to V), however, the mortality rate was low (0%). In conclusion, the Pneumonia PORT prediction rule is effective for evaluating the severity of CAP in Japan, especially in classifying the class V patients who are related to high mortality. The mortality rate of the patients with drug-resistant pneumococcal pneumonia was low.

Aged↗
PubMedDate not supplied

Relationship between blood flow kinetics and severity of Alzheimer's disease: assessment of severity using a questionnaire-type examination, Alzheimer's disease assessment scale, cognitive sub-scale (ADAS(cog)).

We assessed hemokinetics associated with changes in Alzheimer's disease (AD) severity in 90 AD patients by researching the relationship between AD Assessment Scale, cognitive sub-scale (ADAS(cog)) scores and regional cerebral blood flow (rCBF). In the present study, we employed the questionnaire-type ADAS(cog) examination to accurately assess the severity of AD. Between five groups classified on the basis of ADAS(cog) score, significant differences were observed in parietal, lateral temporal and superior frontal rCBF. In addition, in parietal and lateral temporal regions, significant correlations were also observed between ADAS(cog) score and rCBF. In superior frontal rCBF, significant differences were noted only between group 5 (> or =40 ADAS(cog) points) and each of the other groups; there was no significant correlation between rCBF and ADAS(cog) score. Thus, we propose the following mechanism for blood flow kinetics associated with changed severity: In an early stage of AD, blood flow in the medial temporal cortex is impaired, and gradually involves the temporoparietal regions. While the medial temporal impairment of blood flow reaches a plateau, temporoparietal blood flow continues to be impaired well into a severe stage, at which point blood flow impairment in the frontal region is initiated.

Aged↗
PubMed2006

Projected valve area at normal flow rate improves the assessment of stenosis severity in patients with low-flow, low-gradient aortic stenosis: the multicenter TOPAS (Truly or Pseudo-Severe Aortic Stenosis) study.

BACKGROUND: We sought to investigate the use of a new parameter, the projected effective orifice area (EOAproj) at normal transvalvular flow rate (250 mL/s), to better differentiate between truly severe (TS) and pseudo-severe (PS) aortic stenosis (AS) during dobutamine stress echocardiography (DSE). Changes in various parameters of stenosis severity have been used to differentiate between TS and PS AS during DSE. However, the magnitude of these changes lacks standardization because they are dependent on the variable magnitude of the transvalvular flow change occurring during DSE. METHODS AND RESULTS: The use of EOAproj to differentiate TS from PS AS was investigated in an in vitro model and in 23 patients with low-flow AS (indexed EOA <0.6 cm2/m2, left ventricular ejection fraction < or =40%) undergoing DSE and subsequent aortic valve replacement. For an individual valve, EOA was plotted against transvalvular flow (Q) at each dobutamine stage, and valve compliance (VC) was derived as the slope of the regression line fitted to the EOA versus Q plot; EOAproj was calculated as EOAproj=EOArest+VCx(250-Q(rest)), where EOArest and Q(rest) are the EOA and Q at rest. Classification between TS and PS was based on either response to flow increase (in vitro) or visual inspection at surgery (in vivo). EOAproj was the most accurate parameter in differentiating between TS and PS both in vitro and in vivo. In vivo, 15 of 23 patients (65%) had TS and 8 of 23 (35%) had PS. The percentage of correct classification was 83% for EOAproj and 91% for indexed EOAproj compared with percentages of 61% to 74% for the other echocardiographic parameters usually used for this purpose. CONCLUSIONS: EOAproj provides a standardized evaluation of AS severity with DSE and improves the diagnostic accuracy for distinguishing TS and PS AS in patients with low-flow, low-gradient AS.

Aged↗
PubMed2005

Multiple Sclerosis Severity Score: using disability and disease duration to rate disease severity.

BACKGROUND: There is no consensus method for determining progression of disability in patients with multiple sclerosis (MS) when each patient has had only a single assessment in the course of the disease. METHODS: Using data from two large longitudinal databases, the authors tested whether cross-sectional disability assessments are representative of disease severity as a whole. An algorithm, the Multiple Sclerosis Severity Score (MSSS), which relates scores on the Expanded Disability Status Scale (EDSS) to the distribution of disability in patients with comparable disease durations, was devised and then applied to a collection of 9,892 patients from 11 countries to create the Global MSSS. In order to compare different methods of detecting such effects the authors simulated the effects of a genetic factor on disability. RESULTS: Cross-sectional EDSS measurements made after the first year were representative of overall disease severity. The MSSS was more powerful than the other methods the authors tested for detecting different rates of disease progression. CONCLUSION: The Multiple Sclerosis Severity Score (MSSS) is a powerful method for comparing disease progression using single assessment data. The Global MSSS can be used as a reference table for future disability comparisons. While useful for comparing groups of patients, disease fluctuation precludes its use as a predictor of future disability in an individual.

Adult↗
PubMed2005

Studies of very severe short stature with severe GH deficiency: from the data registered with the foundation for growth science.

The ratio, clinical characteristics, and therapeutic efficacy of hGH treatment in patients with severe short stature (HtSDS below -4SD) with severe GHD (all peak GH values to provocation tests: below 2 mug/L) were studied. From March 1986 to January 1998, 23,110 patients with idiopathic GH deficiency (IGHD) were registered with the Foundation for Growth Science, Japan. These subjects were divided into 5 groups as follows: Group 1 (G1), all subjects; Group 2 (G2), at least one GH peak to provocative test > or = 5 microg/L; Group 3 (G3), 2 microg/L < or = GH peak<5 microg/L; Group 4 (G4), all GH peaks<2 microg/L and HtSDS>-4; Group 5 (G5), all GH peaks<2 microg/L and HtSDS< or = -4. The ratio of G5 was 139 patients (0.6%) out of 23,110 patients with IGHD. In G5, there were no significant differences in birth weight, birth length, gestational age and parental height between G2, G3 and G4. However, asphyxia at delivery was more frequent in G5 and G4 than G2 and G3. Chronological age (CA), bone age (BA) and BA/CA ratio at registration were significantly lower in G5 than G2, G3 and G4. Further, the IGF-I SD score in G5 was significantly lower than those in G2 and G3. After hGH treatment, the final height and final height SDS in G5 remained the lowest, while the DeltaHtSDS value in G5 was the greatest among G2 to G5 groups. In conclusion, the ratio of severe short stature with severe GH deficiency (G5) is only 0.6% of all IGHD cases. Growth failure in G5 seems to occur after birth, and its etiology in G5 seems to be different from that of patients with other forms of IGHD. Early diagnosis and hGH treatment are needed to attain better final height.

Age Determination by Skeleton↗
PubMed1997

All-payer severity-adjusted diagnosis-related groups: a uniform method to severity-adjust discharge data.

Measuring severity of illness within diagnosis-related groups (DRGs) has become increasingly important because of the growing need to compare outcomes across providers. In response to these needs, the Health Care Financing Administration (HCFA) has developed a DRG-based severity system as a refinement to its current Medicare DRG structure. As a result of this recent HCFA research, all-payer severity-adjusted DRGs (APS-DRGs) have been developed to provide a uniform approach for severity classification that is also applicable to the all-payer population.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2005

The use of the multi-organ-dysfunction score to discriminate different levels of severity in severe and complicated Plasmodium falciparum malaria.

Clinical presentation of Plasmodium falciparum malaria reflects a continuum from asymptomatic to multi-organ manifestation and death. Severe malaria is defined by the World Health Organization as a qualitative variable. We used the multi-organ dysfunction score (MODS) as a quantitative approach for severity in 29 patients with severe and complicated P. falciparum malaria to test its usefulness in discriminating different severity levels. The MODS on admission was highly correlated with the duration of symptoms after admission (r = 0.73, P < 0.001) and the serum level of tumor necrosis factor alpha (r = 0.41, P = 0.03). In addition, the simplified MODS, based mainly on clinical findings, was also correlated with liver and renal dysfunction during hospitalization (alanine transaminase, r = 0.42, P = 0.02; blood urea nitrogen, r = 0.45, P = 0.015). A score >or= 16 was associated with significantly longer disease duration (P = 0.018). Thus, this score might provide a predictive value for morbidity in P. falciparum malaria.

Adolescent↗
PubMed2005

Correlating crash severity with injury risk, injury severity, and long-term symptoms in low velocity motor vehicle collisions.

BACKGROUND: Auto insurers use a variety of techniques to control their losses, and one that has been widely employed since the mid-1990's is the Minor Impact Soft Tissue (MIST) segmentation strategy. MIST protocol dictates that all injury claims resulting from collisions producing US dollars 1000 or less in damage be "segmented", or adjusted for minimal compensation. MATERIAL/METHODS: Multiple databases were searched for studies comparing any of three dependent variables (injury risk, injury severity, or duration of symptoms) with structural damage in motor vehicle crashes of under 40 km/h (25 mph). RESULTS: A limited correlation between crash severity and injury claims was found. We could not determine, however, whether this relationship held across all crash severities. Other studies provided conflicting results with regard to acute injury risk, but both found no statistically significant correlation between crash severity and long-term outcome. CONCLUSIONS: A substantial number of injuries are reported in crashes of little or no property damage. Property damage is an unreliable predictor of injury risk or outcome in low velocity crashes. The MIST protocol for prediction of injury does not appear to be valid.

Accidents, Traffic↗
PubMed1989

Measuring severity of illness: a comparison of interrater reliability among severity methodologies.

Methods for measuring illness severity are receiving increasing attention from payers, purchasers, and others interested in the equity and financial incentives of prospective payment systems, as well as from those concerned with the use of mortality rates and other outcomes to measure quality of care. Several methodologies have been proposed for measuring the severity of illness of patients admitted to hospitals. When choosing among the available measures, one characteristic of interest is reliability. In this paper, we present a comparative evaluation of interrater reliability among four severity measures--APACHE II, MedisGroups, Patient Management Categories (PMCs), and Disease Staging Q-Scale--as well as for the Diagnosis Related Groups (DRG) classification system. The results show APACHE II, MedisGroups, and DRGs to be highly reliable, with Inter-Rater Reliability Coefficient (RI) values greater than .8. PMCs and Disease Staging Q-Scale were able to achieve fair-to-good levels of reliability. Results are consistent regardless of which reliability statistics are used.

Evaluation Studies as Topic↗
PubMed1997

[A methodology for the objective assessment of trauma severity (III. The assessment of the severity of the state of wounded and injured patients)].

The article describes original scales for the estimation of the severity of state of patients with wounds and traumas. The scale I has been developed for using at the first level of the objective estimation of severity of the wounded's state during the medical sorting. It allows the sorting to be performed very exactly and has advantages over the analogues known in the literature. At the second level the scale II is used which is meant for the estimation of the severity of the wounded's state on admission to the hospital, while at the third level the scale III is used in the dynamics of treatment. These scales are necessary due to different qualitative and quantitative signs used during making the diagnosis and different values of the diagnostic signs for establishing the probability of lethal outcomes and complications on admission to the hospital and a day after performing a complex of resuscitation measures and intensive therapy. A distinctive feature of these scales is their polycriterial character, i.e. each code of the severity is calculated according to two criteria: probability of the development of lethal outcome and complications of the injury. The scales are based on simple symptoms and can be used under the military field conditions and in extreme situations.

Humans↗
PubMed1999

Memantine in severe dementia: results of the 9M-Best Study (Benefit and efficacy in severely demented patients during treatment with memantine).

OBJECTIVES: To assess clinical efficacy and safety of memantine--an uncompetitive N-methyl-D-aspartate (NMDA) antagonist--in moderately severe to severe primary dementia. MATERIALS AND METHODS: Dementia was defined by DSM-III-R criteria and severity was assessed by the Global Deterioration Scale (stages 5-7) and the Mini-Mental State Examination (< 10 points). Primary endpoints were the Clinical Global Impression of Change (CGI-C) rated by the physician, and the Behavioural Rating Scale for Geriatric Patients (BGP), subscore 'care dependence', rated by the nursing staff. Secondary endpoints included the modified D-Scale (Arnold/Ferm). RESULTS: The ITT sample comprised 166 patients and 151 patients were treated per protocol. At 12-week ITT endpoint analysis, 82 received memantine 10 mg per day, 84 placebo. Dementia was in 49% of the Alzheimer type and in 51% of the vascular type (CT, Hachinski score). A positive response in the CGI-C was seen in 73% versus 45% in favour of memantine (stratified Wilcoxon p < 0.001), independent of the etiology of dementia. The results in the BGP subscore 'care dependence' were 3.1 points improvement under memantine and 1.1 points under placebo (p = 0.016). A coincident response of the two independent target variables was observed in 61.3% (memantine) versus 31.6% (placebo). Secondary endpoint analysis of the D-Scale assessing basic ADL functions support the primary results. Regarding the safety profile, no significant differences between treatment groups were observed. CONCLUSIONS: The results of this trial support the hypothesis that memantine treatment leads to functional improvement and reduces care dependence in severely demented patients.

Activities of Daily Living↗
PubMed2004

Association of severe vertebral fractures with reduced quality of life: reduction in the incidence of severe vertebral fractures by teriparatide.

OBJECTIVE: The association between vertebral fracture severity and health-related quality of life (HRQOL) was investigated in a subset of patients in the Fracture Prevention Trial. We sought to determine whether vertebral fracture severity was associated with HRQOL scores, and if so, to determine the effects of teriparatide (recombinant human parathyroid hormone 1-34) on vertebral fracture grades that most strongly impact HRQOL in postmenopausal women with osteoporosis. METHODS: Vertebral fracture severity was assessed by the visual semiquantitative (SQ) method. A subset of 444 patients with a baseline radiograph completed the Osteoporosis Assessment Questionnaire. Baseline HRQOL scores were modeled as a function of maximum baseline vertebral fracture grade, while controlling for age, bone mineral density, body mass index, and back pain. RESULTS: The effect of baseline vertebral fracture grade on baseline HRQOL was statistically significant, while interactions between vertebral fracture grade and the other variables were not statistically significant. SQ grade 3 (SQ3) vertebral fractures were associated with a significantly lower overall HRQOL score and with significantly lower physical function, symptoms, and emotional status dimension scores. After a median of 19 months of therapy, new or worsening SQ3 vertebral fractures occurred in 21 of 448 patients (4.7%) in the placebo group compared with 3 of 444 patients (0.7%) in the 20 mug/day teriparatide group. The risk of developing a new or worsened SQ3 vertebral fracture was reduced by 86% (P < 0.001) in patients treated with 20 mug/day teriparatide. CONCLUSION: Compared with prevalent fractures of lesser severity, SQ3 vertebral fractures were associated with reduced HRQOL. Teriparatide treatment significantly reduced the risk of new or worsening SQ3 vertebral fractures. These findings suggest, but do not directly demonstrate, a benefit of teriparatide on HRQOL.

Aged↗
PubMed1990

The efficacy and safety of quinapril in the treatment of moderate to severe and severe hypertension: comparison to captopril.

Major studies comparing the efficacy and safety of quinapril and captopril in the treatment of moderate to severe or severe hypertension are reviewed. Given concurrently with hydrochlorothiazide 25 mg/day to patients with moderate to severe hypertension, quinapril 20-80 mg/day twice daily was found to be more effective than captopril 50-200 mg/day twice daily, and quinapril 10-40 mg/day once daily was found to be as effective as captopril 25-100 mg/day twice daily. Given as initial monotherapy to patients with severe hypertension, quinapril 10-40 mg/day twice daily was found to be as effective as captopril 50-200 mg/day twice daily. Quinapril was found to be well tolerated, both when administered against a diuretic background and when diuretic was added to a quinapril regimen.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2004

Procalcitonin: improved biochemical severity stratification and postoperative monitoring in severe abdominal inflammation and sepsis.

BACKGROUND: Infections and sepsis are among the most devastating complications in abdominal surgery and significantly contribute to morbidity and mortality. Early and reliable diagnosis of septic complications is notoriously difficult, and the search for novel approaches to overcome this problem is still a compelling issue for clinicians. Among a large array of inflammatory parameters, procalcitonin (PCT), the 116-amino-acid pro-peptide of calcitonin, has gained considerable importance in identifying patients at risk of developing infection and sepsis in clinical practice. METHODS: Along with the latest insights into pathophysiological aspects of this pro-hormone, the literature as well as our own experience on the usefulness of PCT determinations in patients with severe inflammatory abdominal disorders was reviewed. RESULTS: Although the term "sepsis" does not embrace the integral properties of PCT, a remarkable number of clinical studies have demonstrated the pivotal role of this parameter in the host response to microbial and fungal infections. In acute pancreatitis PCT allows early severity stratification and closely correlates with the development of subsequent pancreatic infections. In patients with peritonitis PCT reflects overall disease severity and is an early and reliable indicator of overall prognosis. Postoperative monitoring of PCT is a helpful tool to identify patients with evolving or persisting septic complications after elective and emergency abdominal surgery. CONCLUSIONS: Compared with established biochemical routine variables, PCT significantly contributes to earlier and better stratification of patients at risk of developing septic complications and provides excellent prognostic assessment in severe abdominal inflammation. The currently available test systems render PCT an applicable and readily available parameter under clinical routine and emergency conditions.

Abdomen↗
PubMed1996

Dobutamine-induced hypoperfusion without transient wall motion abnormalities: less severe ischemia or less severe stress?

OBJECTIVES: This study sought to compare the clinical characteristics, hemodynamic response and severity of ischemia in patients with coronary artery disease and reversible perfusion defects on dobutamine 2-methoxy isobutyl isonitrile (MIBI) single-photon emission computed tomography (SPECT) with or without transient wall motion abnormalities. BACKGROUND: The occurrence of reversible perfusion defects without concomitant wall motion abnormalities in patients with coronary artery disease was attributed to less severe ischemia. However, little data are available to support this observation. METHODS: Fifty-four consecutive patients with significant coronary artery disease and reversible perfusion defects on dobutamine (up to 40 micrograms/kg body weight per min) MIBI SPECT were studied (mean [+/- SD] age 59 +/- 11 years; 38 men, 16 women). All patients underwent simultaneous echocardiography. The myocardium was divided into six matched segments, and ischemic perfusion score was quantitatively derived in myocardial segments with reversible defects. RESULTS: New or worsening wall motion abnormalities occurred in 40 patients (74%) (group A) and were absent in 14 (26%) (group B). There was no significant difference between the two groups with respect to age, previous myocardial infarction, number of abnormal coronary arteries (1.8 +/- 0.8 vs. 1.6 +/- 0.9), number of reversible perfusion defects (1.6 +/- 0.9 vs. 1.8 +/- 0.7) or ischemic perfusion score (412 +/- 750 vs. 526 +/- 553). Patients in group A had a higher prevalence of male gender (80% vs. 43%, p < 0.01), higher peak systolic blood pressure (147 +/- 30 vs. 127 +/- 31 mm Hg, p < 0.05), higher peak rate-pressure product (19,632 +/- 4,081 vs. 16,939 +/- 4,344, p < 0.01) and a higher prevalence of angina (53% vs. 14%) and ST segment depression (55% vs. 14%) than group B (p < 0.05 for both). CONCLUSIONS: In patients with coronary artery disease and ischemia on dobutamine MIBI SPECT, the absence of transient wall motion abnormalities is associated with a similar extent and severity of reversible perfusion defects, a lower stress rate-pressure product and a higher prevalence of female gender than patients with transient wall motion abnormalities. Mechanically silent ischemia should not be regarded as a marker of less severe ischemia on myocardial perfusion scintigraphy.

Adrenergic beta-Antagonists↗