Professor Pinto received his MD and PhD from the Lisbon University Medical School and completed fellowships at Santa Maria University Hospital (Lisbon, Portugal), and Stanford University Medical School (CA, USA), where he was also Clinical Attending in the Echocardiography laboratory. He is Full Professor of Cardiology/Medicine alongside serving as the Head of the Cardiovascular Department of Santa Maria University Hospital and President of Cardiovascular Center of University of Lisbon (CCUL). He was the Dean of the Faculty of Medicine of the University of Lisbon (2015-22) as well as National Coordinator of the Medical Schools Council (2018-2020), President of the Executive Board of the Lisbon Academic Medical Centre (2019-21).Professor Pinto was the President and founder of the European Association of Echocardiography (2003-2004), President of the European Society of Cardiology (2014-2016) and President of the World Heart Federation (2021-22). He is a Fellow of the European Society of Cardiology (FESC), European Association of Cardiovascular Imaging (FEACVI), American College of Cardiology (FACC), American Society of Angiology (FASA) , Society for Cardiac Angiography and Interventions (FSCAI) and the American Society of Echocardiography (FASE) and honorary member of several international societies and academies.Prof. Pinto has published over 600 papers. He was the Editor in Chief of the Portuguese Journal of Cardiology and is currently Consulting Editor and Member of the Advisory and Editorial Board of several peer-reviewed journals. Main areas of interest are global health, digital health, ischemic heart disease, heart failure, anticoagulation, and cardiovascular imaging, with particular interest in the use of ultrasound in cardiology and has pioneered the use of intravascular ultrasound in the study of graft atherosclerosis.
Cardiac alterations are frequently observed after acute neurological disorders. Takotsubo syndrom... more Cardiac alterations are frequently observed after acute neurological disorders. Takotsubo syndrome (TTS) represents an acute heart failure syndrome and is increasingly recognized as part of the spectrum of cardiac complications observed after neurological disorders. A systematic investigation of TTS patients with neurological disorders has not been conducted yet. The aim of the study was to expand insights regarding neurological disease entities triggering TTS and to investigate the clinical profile and outcomes of TTS patients after primary neurological disorders. The International Takotsubo Registry is an observational multicenter collaborative effort of 45 centers in 14 countries (ClinicalTrials.gov, identifier NCT01947621). All patients in the registry fulfilled International Takotsubo Diagnostic Criteria. For the present study, patients were included if complete information on acute neurological disorders were available. 2402 patients in whom complete information on acute neuro...
Background Ethnic disparities have been reported in cardiovascular disease. However, ethnic dispa... more Background Ethnic disparities have been reported in cardiovascular disease. However, ethnic disparities in takotsubo syndrome (TTS) remain elusive. This study assessed differences in clinical characteristics between Japanese and European TTS patients and determined the impact of ethnicity on in-hospital outcomes. Methods TTS patients in Japan were enrolled from 10 hospitals and TTS patients in Europe were enrolled from 32 hospitals participating in the International Takotsubo Registry. Clinical characteristics and in-hospital outcomes were compared between Japanese and European patients. Results A total of 503 Japanese and 1670 European patients were included. Japanese patients were older (72.6 ± 11.4 years vs. 68.0 ± 12.0 years; p < 0.001) and more likely to be male (18.5 vs. 8.4%; p < 0.001) than European TTS patients. Physical triggering factors were more common (45.5 vs. 32.0%; p < 0.001), and emotional triggers less common (17.5 vs. 31.5%; p < 0.001), in Japanese pa...
Background Atrial fibrillation (AF) is a major risk factor for mortality. The prevalence, clinica... more Background Atrial fibrillation (AF) is a major risk factor for mortality. The prevalence, clinical correlates, and prognostic impact of AF in Takotsubo syndrome (TTS) have not yet been investigated in a large patient cohort. This study aimed to investigate the prevalence, clinical correlates, and prognostic impact of AF in patients with TTS. Methods and Results Patients with TTS were enrolled from the International Takotsubo Registry, which is a multinational network with 26 participating centers in Europe and the United States. Patients were dichotomized according to the presence or absence of AF at the time of admission. Of 1584 patients with TTS, 112 (7.1%) had AF. The mean age was higher ( P <0.001), and there were fewer women ( P =0.046) in the AF than in the non‐AF group. Left ventricular ejection fraction was significantly lower ( P =0.001), and cardiogenic shock was more often observed ( P <0.001) in the AF group. Both in‐hospital ( P <0.001) and long‐term mortality...
AimsAcute pulmonary disorders are known physical triggers of takotsubo syndrome (TTS). This study... more AimsAcute pulmonary disorders are known physical triggers of takotsubo syndrome (TTS). This study aimed to investigate prevalence of acute pulmonary triggers in patients with TTS and their impact on outcomes.Methods and resultsPatients with TTS were enrolled from the International Takotsubo Registry and screened for triggering factors and comorbidities. Patients were categorized into three groups (acute pulmonary trigger, chronic lung disease, and no lung disease) to compare clinical characteristics and outcomes.Of the 1670 included patients with TTS, 123 (7%) were identified with an acute pulmonary trigger, and 194 (12%) had a known history of chronic lung disease. The incidence of cardiogenic shock was highest in patients with an acute pulmonary trigger compared with those with chronic lung disease or without lung disease (17% vs. 10% vs. 9%, P = 0.017). In‐hospital mortality was also higher in patients with an acute pulmonary trigger than in the other two groups, although not sig...
BackgroundLeft ventricular (LV) lead placement is the most challenging aspect of cardiac resynchr... more BackgroundLeft ventricular (LV) lead placement is the most challenging aspect of cardiac resynchronization therapy (CRT) device implantation, with a failure rate of up to 10% due to complex coronary anatomies. We describe a modified snare technique for LV lead placement and evaluate its safety and efficacy in cases when standard methods fail.Methods and ResultsA prospective study was conducted of patients indicated for a CRT implant. When LV lead delivery to the target vessel failed using standard techniques, a modified snare technique was employed. Patients were evaluated every 6 months. From 2015 to 2019, 566 CRTs were implanted (26.1% female, 72 ± 10.2 years old, follow‐up duration 18.9 ± 15.8 months). The standard LV implant technique failed in 94 cases (16.6%), of which the modified snare technique was successful in 92 (97.9%). There were no differences between the modified snare and standard techniques in the rates of 30‐day postimplant CRT all‐cause mortality (3.2% vs. 1.7%, ...
Aims Takotsubo syndrome (TTS) is an acute heart failure syndrome, which shares many features with... more Aims Takotsubo syndrome (TTS) is an acute heart failure syndrome, which shares many features with acute coronary syndrome (ACS). Although TTS was initially described with angiographically normal coronary arteries, smaller studies recently indicated a potential coexistence of coronary artery disease (CAD) in TTS patients. This study aimed to determine the coexistence, features, and prognostic role of CAD in a large cohort of patients with TTS. Methods and results Coronary anatomy and CAD were studied in patients diagnosed with TTS. Inclusion criteria were compliance with the International Takotsubo Diagnostic Criteria for TTS, and availability of original coronary angiographies with ventriculography performed during the acute phase. Exclusion criteria were missing views, poor quality of angiography loops, and angiography without ventriculography. A total of 1016 TTS patients were studied. Of those, 23.0% had obstructive CAD, 41.2% had non-obstructive CAD, and 35.7% had angiographical...
Background Left ventricular ( LV ) recovery in takotsubo syndrome ( TTS ) occurs over a wide‐rang... more Background Left ventricular ( LV ) recovery in takotsubo syndrome ( TTS ) occurs over a wide‐ranging interval, varying from hours to weeks. We sought to investigate the clinical predictors and prognostic impact of recovery time for TTS patients. Methods and Results TTS patients from the International Takotsubo Registry were included in this study. Cut‐off for early LV recovery was determined to be 10 days after the acute event. Multivariable logistic regression was used to assess factors associated with the absence of early recovery. In‐hospital outcomes and 1‐year mortality were compared for patients with versus without early recovery. We analyzed 406 patients with comprehensive and serial imaging data regarding time to recovery. Of these, 191 (47.0%) had early LV recovery and 215 (53.0%) demonstrated late LV improvement. Patients without early recovery were more often male (12.6% versus 5.2%; P =0.011) and presented more frequently with typical TTS (76.3% versus 67.0%, P =0.040). ...
Takotsubo cardiomyopathy (TTC) is characterized by reversible left ventricular apical and/or midv... more Takotsubo cardiomyopathy (TTC) is characterized by reversible left ventricular apical and/or midventricular hypokinesia with unknown etiology. The clinical presentation is similar to acute myocardial infarction in the absence of significant obstructive coronary artery disease. Various predisposing factors have been related to TTC, such as acute neurological illnesses, endocrine diseases, pain, and emotional stress. We present the first description of an association between TTC cardiomyopathy and panhypopituitarism. This case reinforces the connection between the hormonal and cardiovascular systems. Furthermore, it supports the importance of a comprehensive and integrated medical history in the approach of a patient with cardiac disease, towards clinical decision-making.
Introduction: the results of surgical procedures in cardiac surgery depend, to a great extent, on... more Introduction: the results of surgical procedures in cardiac surgery depend, to a great extent, on the quality of post-operative care. The complexity of the evolution of these patients requires attention from specialized personnel and a differentiated support structure. Objectives: to characterize patients in the postoperative period of cardiac surgery and to describe the main postoperative complications. Methods: we conducted a cross-sectional descriptive study of cases operated and received in the postoperative period of cardiac surgery at the Hospital Provincial Universitario Cardiocentro “Ernesto Guevara” during 2018. Results: 161 cardiac surgery patients were received in the postoperative period; 70.8% were male and most of them were between 45 and 54 years old (32.3%); valve surgery was performed on 49.1%; 16.1% of the total patients were ventilated for more than 48 hours and many were complicated by nosocomial pneumonia (11.8%) and there was a very low frequency of post-operat...
Arteriosclerosis, Thrombosis, and Vascular Biology, 2020
Objective: Takotsubo syndrome (TTS) is characterized by acute left ventricular dysfunction, which... more Objective: Takotsubo syndrome (TTS) is characterized by acute left ventricular dysfunction, which can contribute to intraventricular thrombus and embolism. Still, prevalence and clinical impact of thrombus formation and embolic events on outcome of TTS patients remain unclear. This study aimed to investigate clinical features and outcomes of patients with and without intraventricular thrombus or embolism. Additionally, factors associated with thrombus formation or embolism, as well as predictors for mortality, were identified. Approach and Results: TTS patients enrolled in the International Takotsubo Registry at 28 centers in Australia, Europe, and the United States were dichotomized according to the occurrence/absence of intraventricular thrombus or embolism. Patients with intraventricular thrombus or embolism were defined as the ThrombEmb group. Of 1676 TTS patients, 56 (3.3%) patients developed intraventricular thrombus and/or embolism following TTS diagnosis (median time interva...
Heart disease is one of the leading causes of death in the United States. With the increase in su... more Heart disease is one of the leading causes of death in the United States. With the increase in substance abuse, the incidence of acute myocardial infarction (MI) in younger population has been on the rise. Traditionally, cocaine has been blamed for acute MI; however, recently, there have been more incidences of marijuana as an inciting factor. We present a case of marijuana-induced acute MI and discuss the proposed mechanism.
Although dobutamine stress echocardiography (DSE) is cited in clinical guidelines for the evaluat... more Although dobutamine stress echocardiography (DSE) is cited in clinical guidelines for the evaluation of patients with chronic kidney disease (CKD), there are limited data regarding its prognostic utility in this setting. The current study assesses the prognostic value of DSE in patients with CKD. Four hundred eighty-five patients with CKD (on renal dialysis or with creatinine &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 3 mg/mL) who had DSE were followed for 2.3 +/- 1.8 years. One hundred eighty-eight (39%) patients died during follow-up. Patients with extensive ischemia (affecting &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 25% of myocardial segments) had a 1- and 3-year survival rate of 77% and 48%, respectively, compared with 83% and 52% in those with lesser degrees (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 25% segments affected) of ischemia and with 88% and 70% in those with a normal DSE. In multivariate analyses, the percentage of ischemic segments on DSE was an independent predictor of all-cause mortality (hazard ratio, 1.40 per 25% increase; 95% CI, 1.16-1.68; P = .001). Inclusion of DSE data improved the predictive value of the best clinical model (chi2, 83.6-97.4; P = .003). In patients with CKD, the percentage of ischemic segments during DSE is an independent predictor of mortality and provides prognostic information that is incremental to clinical data.
Cardiac alterations are frequently observed after acute neurological disorders. Takotsubo syndrom... more Cardiac alterations are frequently observed after acute neurological disorders. Takotsubo syndrome (TTS) represents an acute heart failure syndrome and is increasingly recognized as part of the spectrum of cardiac complications observed after neurological disorders. A systematic investigation of TTS patients with neurological disorders has not been conducted yet. The aim of the study was to expand insights regarding neurological disease entities triggering TTS and to investigate the clinical profile and outcomes of TTS patients after primary neurological disorders. The International Takotsubo Registry is an observational multicenter collaborative effort of 45 centers in 14 countries (ClinicalTrials.gov, identifier NCT01947621). All patients in the registry fulfilled International Takotsubo Diagnostic Criteria. For the present study, patients were included if complete information on acute neurological disorders were available. 2402 patients in whom complete information on acute neuro...
Background Ethnic disparities have been reported in cardiovascular disease. However, ethnic dispa... more Background Ethnic disparities have been reported in cardiovascular disease. However, ethnic disparities in takotsubo syndrome (TTS) remain elusive. This study assessed differences in clinical characteristics between Japanese and European TTS patients and determined the impact of ethnicity on in-hospital outcomes. Methods TTS patients in Japan were enrolled from 10 hospitals and TTS patients in Europe were enrolled from 32 hospitals participating in the International Takotsubo Registry. Clinical characteristics and in-hospital outcomes were compared between Japanese and European patients. Results A total of 503 Japanese and 1670 European patients were included. Japanese patients were older (72.6 ± 11.4 years vs. 68.0 ± 12.0 years; p < 0.001) and more likely to be male (18.5 vs. 8.4%; p < 0.001) than European TTS patients. Physical triggering factors were more common (45.5 vs. 32.0%; p < 0.001), and emotional triggers less common (17.5 vs. 31.5%; p < 0.001), in Japanese pa...
Background Atrial fibrillation (AF) is a major risk factor for mortality. The prevalence, clinica... more Background Atrial fibrillation (AF) is a major risk factor for mortality. The prevalence, clinical correlates, and prognostic impact of AF in Takotsubo syndrome (TTS) have not yet been investigated in a large patient cohort. This study aimed to investigate the prevalence, clinical correlates, and prognostic impact of AF in patients with TTS. Methods and Results Patients with TTS were enrolled from the International Takotsubo Registry, which is a multinational network with 26 participating centers in Europe and the United States. Patients were dichotomized according to the presence or absence of AF at the time of admission. Of 1584 patients with TTS, 112 (7.1%) had AF. The mean age was higher ( P <0.001), and there were fewer women ( P =0.046) in the AF than in the non‐AF group. Left ventricular ejection fraction was significantly lower ( P =0.001), and cardiogenic shock was more often observed ( P <0.001) in the AF group. Both in‐hospital ( P <0.001) and long‐term mortality...
AimsAcute pulmonary disorders are known physical triggers of takotsubo syndrome (TTS). This study... more AimsAcute pulmonary disorders are known physical triggers of takotsubo syndrome (TTS). This study aimed to investigate prevalence of acute pulmonary triggers in patients with TTS and their impact on outcomes.Methods and resultsPatients with TTS were enrolled from the International Takotsubo Registry and screened for triggering factors and comorbidities. Patients were categorized into three groups (acute pulmonary trigger, chronic lung disease, and no lung disease) to compare clinical characteristics and outcomes.Of the 1670 included patients with TTS, 123 (7%) were identified with an acute pulmonary trigger, and 194 (12%) had a known history of chronic lung disease. The incidence of cardiogenic shock was highest in patients with an acute pulmonary trigger compared with those with chronic lung disease or without lung disease (17% vs. 10% vs. 9%, P = 0.017). In‐hospital mortality was also higher in patients with an acute pulmonary trigger than in the other two groups, although not sig...
BackgroundLeft ventricular (LV) lead placement is the most challenging aspect of cardiac resynchr... more BackgroundLeft ventricular (LV) lead placement is the most challenging aspect of cardiac resynchronization therapy (CRT) device implantation, with a failure rate of up to 10% due to complex coronary anatomies. We describe a modified snare technique for LV lead placement and evaluate its safety and efficacy in cases when standard methods fail.Methods and ResultsA prospective study was conducted of patients indicated for a CRT implant. When LV lead delivery to the target vessel failed using standard techniques, a modified snare technique was employed. Patients were evaluated every 6 months. From 2015 to 2019, 566 CRTs were implanted (26.1% female, 72 ± 10.2 years old, follow‐up duration 18.9 ± 15.8 months). The standard LV implant technique failed in 94 cases (16.6%), of which the modified snare technique was successful in 92 (97.9%). There were no differences between the modified snare and standard techniques in the rates of 30‐day postimplant CRT all‐cause mortality (3.2% vs. 1.7%, ...
Aims Takotsubo syndrome (TTS) is an acute heart failure syndrome, which shares many features with... more Aims Takotsubo syndrome (TTS) is an acute heart failure syndrome, which shares many features with acute coronary syndrome (ACS). Although TTS was initially described with angiographically normal coronary arteries, smaller studies recently indicated a potential coexistence of coronary artery disease (CAD) in TTS patients. This study aimed to determine the coexistence, features, and prognostic role of CAD in a large cohort of patients with TTS. Methods and results Coronary anatomy and CAD were studied in patients diagnosed with TTS. Inclusion criteria were compliance with the International Takotsubo Diagnostic Criteria for TTS, and availability of original coronary angiographies with ventriculography performed during the acute phase. Exclusion criteria were missing views, poor quality of angiography loops, and angiography without ventriculography. A total of 1016 TTS patients were studied. Of those, 23.0% had obstructive CAD, 41.2% had non-obstructive CAD, and 35.7% had angiographical...
Background Left ventricular ( LV ) recovery in takotsubo syndrome ( TTS ) occurs over a wide‐rang... more Background Left ventricular ( LV ) recovery in takotsubo syndrome ( TTS ) occurs over a wide‐ranging interval, varying from hours to weeks. We sought to investigate the clinical predictors and prognostic impact of recovery time for TTS patients. Methods and Results TTS patients from the International Takotsubo Registry were included in this study. Cut‐off for early LV recovery was determined to be 10 days after the acute event. Multivariable logistic regression was used to assess factors associated with the absence of early recovery. In‐hospital outcomes and 1‐year mortality were compared for patients with versus without early recovery. We analyzed 406 patients with comprehensive and serial imaging data regarding time to recovery. Of these, 191 (47.0%) had early LV recovery and 215 (53.0%) demonstrated late LV improvement. Patients without early recovery were more often male (12.6% versus 5.2%; P =0.011) and presented more frequently with typical TTS (76.3% versus 67.0%, P =0.040). ...
Takotsubo cardiomyopathy (TTC) is characterized by reversible left ventricular apical and/or midv... more Takotsubo cardiomyopathy (TTC) is characterized by reversible left ventricular apical and/or midventricular hypokinesia with unknown etiology. The clinical presentation is similar to acute myocardial infarction in the absence of significant obstructive coronary artery disease. Various predisposing factors have been related to TTC, such as acute neurological illnesses, endocrine diseases, pain, and emotional stress. We present the first description of an association between TTC cardiomyopathy and panhypopituitarism. This case reinforces the connection between the hormonal and cardiovascular systems. Furthermore, it supports the importance of a comprehensive and integrated medical history in the approach of a patient with cardiac disease, towards clinical decision-making.
Introduction: the results of surgical procedures in cardiac surgery depend, to a great extent, on... more Introduction: the results of surgical procedures in cardiac surgery depend, to a great extent, on the quality of post-operative care. The complexity of the evolution of these patients requires attention from specialized personnel and a differentiated support structure. Objectives: to characterize patients in the postoperative period of cardiac surgery and to describe the main postoperative complications. Methods: we conducted a cross-sectional descriptive study of cases operated and received in the postoperative period of cardiac surgery at the Hospital Provincial Universitario Cardiocentro “Ernesto Guevara” during 2018. Results: 161 cardiac surgery patients were received in the postoperative period; 70.8% were male and most of them were between 45 and 54 years old (32.3%); valve surgery was performed on 49.1%; 16.1% of the total patients were ventilated for more than 48 hours and many were complicated by nosocomial pneumonia (11.8%) and there was a very low frequency of post-operat...
Arteriosclerosis, Thrombosis, and Vascular Biology, 2020
Objective: Takotsubo syndrome (TTS) is characterized by acute left ventricular dysfunction, which... more Objective: Takotsubo syndrome (TTS) is characterized by acute left ventricular dysfunction, which can contribute to intraventricular thrombus and embolism. Still, prevalence and clinical impact of thrombus formation and embolic events on outcome of TTS patients remain unclear. This study aimed to investigate clinical features and outcomes of patients with and without intraventricular thrombus or embolism. Additionally, factors associated with thrombus formation or embolism, as well as predictors for mortality, were identified. Approach and Results: TTS patients enrolled in the International Takotsubo Registry at 28 centers in Australia, Europe, and the United States were dichotomized according to the occurrence/absence of intraventricular thrombus or embolism. Patients with intraventricular thrombus or embolism were defined as the ThrombEmb group. Of 1676 TTS patients, 56 (3.3%) patients developed intraventricular thrombus and/or embolism following TTS diagnosis (median time interva...
Heart disease is one of the leading causes of death in the United States. With the increase in su... more Heart disease is one of the leading causes of death in the United States. With the increase in substance abuse, the incidence of acute myocardial infarction (MI) in younger population has been on the rise. Traditionally, cocaine has been blamed for acute MI; however, recently, there have been more incidences of marijuana as an inciting factor. We present a case of marijuana-induced acute MI and discuss the proposed mechanism.
Although dobutamine stress echocardiography (DSE) is cited in clinical guidelines for the evaluat... more Although dobutamine stress echocardiography (DSE) is cited in clinical guidelines for the evaluation of patients with chronic kidney disease (CKD), there are limited data regarding its prognostic utility in this setting. The current study assesses the prognostic value of DSE in patients with CKD. Four hundred eighty-five patients with CKD (on renal dialysis or with creatinine &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 3 mg/mL) who had DSE were followed for 2.3 +/- 1.8 years. One hundred eighty-eight (39%) patients died during follow-up. Patients with extensive ischemia (affecting &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 25% of myocardial segments) had a 1- and 3-year survival rate of 77% and 48%, respectively, compared with 83% and 52% in those with lesser degrees (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 25% segments affected) of ischemia and with 88% and 70% in those with a normal DSE. In multivariate analyses, the percentage of ischemic segments on DSE was an independent predictor of all-cause mortality (hazard ratio, 1.40 per 25% increase; 95% CI, 1.16-1.68; P = .001). Inclusion of DSE data improved the predictive value of the best clinical model (chi2, 83.6-97.4; P = .003). In patients with CKD, the percentage of ischemic segments during DSE is an independent predictor of mortality and provides prognostic information that is incremental to clinical data.
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