Beware of Dyspnea
Researchers assessed the prognostic meaning of dyspnea in patients presenting for radionuclide stress testing. Based on their responses to questions about dyspnea and chest-pain symptoms, patients were classified into five groups: asymptomatic; non-anginal chest pain; a typical angina; typical angina; and dyspnea without chest pain. Over a 10-year period, nearly 18,000 patients at a Los Angeles medical center were enrolled. Patients with dyspnea were older than those with chest pain and had more comorbidities and classic risk factors, including left ventricular hypertrophy. During a mean follow-up of 2.7 years, rates of both death from any cause and death from cardiac causes were significantly (2 to 3 times) higher in patients with dyspnea than in any of the other groups, even than in patients with typical angina.
This finding held true in patients with and without known coronary disease. After controlling for numerous risk factors, dyspnea remained a significant independent predictor of death. An editorialist notes that diastolic dysfunction, which was not measured in this study, is known to decrease survival, even in the absence of heart failure. The editorialist cautions that “cardiac symptoms other than chest pain are of value in identifying patients . . . who should undergo functional testing.”
