Recent trends including development of new diagnostic and therapeutic modalities and increasing pressure to provide cost-effective care have made risk stratification and technology assessment increasingly important in cardiovascular research. This will be achieved through a series of studies exploring the utility of echocardiography in the risk stratification of patients with chest pain. We hypothesize that routinely available qualitative data from the echocardiogram can be used to risk stratify patients and that such data provide information above and beyond clinical data. Thus, by means of a prospective cohort study, we will: 1) Investigate the correlation between echocardiographic variables and the risk of a. complications during hospitalization; and b. long-term prognosis and functional status. 2) Determine whether echocardiographic variables add incremental risk stratification information after consideration of clinical and electrocardiographic data. 3) Develop and validate prospectively a predictive algorithm based on clinical, electrocardiographic and echocardiographic variables. 4) Assess the cost-effectiveness of performance of routine echocardiography in subsets of patients admitted for acute chest pain. In the latter part of the research program, these methodologies for technologies for technology assessment will be used to evaluate the role of cardiac imaging in other settings such as identification of preoperative predictors of outcome in patients undergoing mitral valve repair and replacement or assessment of aortic regurgitation with magnetic resonance imaging. This research should prove useful to both clinician and health policy maker.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Clinical Investigator Award (CIA) (K08)
Project #
5K08HL002964-02
Application #
2210852
Study Section
Research Training Review Committee (RTR)
Project Start
1994-07-01
Project End
1999-06-30
Budget Start
1995-07-01
Budget End
1996-06-30
Support Year
2
Fiscal Year
1995
Total Cost
Indirect Cost
Name
Brigham and Women's Hospital
Department
Type
DUNS #
071723621
City
Boston
State
MA
Country
United States
Zip Code
02115
Krasuski, R A; Hartley, L H; Lee, T H et al. (1999) Weekend and holiday exercise testing in patients with chest pain. J Gen Intern Med 14:10-4
Hunink, M G; Kuntz, K M; Fleischmann, K E et al. (1999) Noninvasive imaging for the diagnosis of coronary artery disease: focusing the development of new diagnostic technology. Ann Intern Med 131:673-80
Lopez-Jimenez, F; Goldman, L; Johnson, P A et al. (1998) Effect of diabetes mellitus on the presentation and triage of patients with acute chest pain without known coronary artery disease. Am J Med 105:500-5
Fleischmann, K E; Hunink, M G; Kuntz, K M et al. (1998) Exercise echocardiography or exercise SPECT imaging? A meta-analysis of diagnostic test performance. JAMA 280:913-20
Fleischmann, K E; Lee, R T; Come, P C et al. (1997) Clinical and echocardiographic correlates of health status in patients with acute chest pain. J Gen Intern Med 12:751-6
Fleischmann, K E; Lee, T H; Come, P C et al. (1997) Echocardiographic prediction of complications in patients with chest pain. Am J Cardiol 79:292-8
Fleischmann, K E; Lee, R T; Come, P C et al. (1997) Impact of valvular regurgitation and ventricular dysfunction on long-term survival in patients with chest pain. Am J Cardiol 80:1266-72