Prognosebeurteilung von KHK-Patienten: Die Rolle der Stressechokardiografie

Abstract

Stress-echocardiography und myocardial scintigraphy provide similar information on the prognosis of patients with and without heart disease. A normal stress echocardiogram does not exclude coronary stenoses but indicates a prognostically favourable outcome. Patients with a normal stress echocardiogram usually do not need further invasive assessment of coronary artery disease. There is an increasing risk of cardiac mortality and myocardial infarction depending on extent of abnormal findings during stress echocardiography. Stress echocardiography can be used to assess the short term prognosis of patients undergoing major non-cardiac surgery. The results of the stress echocardiogram identify those patients, in major surgery is of high risk. Newer echocardiographic technologies like Doppler tissue imaging, speckle tracking imaging and myocardial contrast echocardiography are promising, but still need to be validated in larger studies.

Kernaussagen

• Stressechokardiografie und Myokardszintigrafie haben bezüglich der Prognose bei Patienten mit und ohne KHK eine ähnliche Aussagekraft.

• Ein normales Stressechokardiogramm schließt Koronarstenosen nicht aus, spricht aber für eine gute Prognose. Die beste Prognose haben diejenigen Patienten, die ein normales Belastungs-Stressechokardiogramm haben.

• Patienten mit einem normalen Belastungs-Stressechokardiogramm benötigen keine weitere Diagnostik, es sei denn, die klinische Symptomatik ändert sich. Auch Patienten mit einem normalen Dobutamin-Stressechokardiogramm benötigen in der Regel keine weitere Diagnostik, wenn kein Diabetes vorliegt.

• Das kardiale Risiko steigt bei Frauen und Männern an, je mehr pathologische Befunde sich in der Stressechokardiografie finden. Auch bei Frauen erlaubt die Belastungs-Stressechokardiografie eine zuverlässige Aussage zum kardiovaskulären Risiko.

• Die Stressechokardiografie erlaubt eine Aussage zur Prognose von Patienten, denen nicht kardiale chirurgische Eingriffe bevorstehen.

Literatur

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