ABSTRACT
INTRODUCTION AND OBJECTIVES: Exercise echocardiography (EE) is useful for diagnosing coronary disease, but little is known about its value for risk stratification. We aimed to determine: a) whether data from EE supplemented clinical data and data from exercise testing and resting echocardiography in predicting cardiac events; and b)whether the number and location of abnormal regions and their responses to exercise influenced risk stratification. PATIENTS AND METHOD: The 2,436 patients referred for EE were followed up for 2.1+/-1.5 years. Some 120 serious cardiovascular events (i.e., non-fatal myocardial infarction or cardiovascular death) occurred before revascularization. RESULTS: In 1203 patients (49%), EE gave abnormal results. There were 89 events in patients with an abnormal result (7.3%) and 31 in those with a normal result (2.5%; P<.0001). Multivariate analysis of clinical data, and data from exercise testing, resting echocardiography, and EE showed that male sex (RR=1.7; 95% CI, 1.1-2.8; P=.02), metabolic equivalents or METs (RR=0.9; 95% CI, 0.86-0.98; P=.01), peak heart rate x blood pressure (RR= 0.9;95% CI, 0.9; P=.002), resting wall motion score index (RR=2.5; 95% CI, 1.5-4.1; P<.0001), and number of abnormal regions at peak exercise (RR=1.4; 95% CI, 1.2-1.7; P<.0001) were independently associated with the risk of a serious event (final model chi2, 170; incremental P<.0001). The same variables, excluding sex, were independently associated with cardiovascular death (final model chi2, 169; incremental P=.01). CONCLUSIONS: Exercise echocardiography supplements clinical data and data from exercise testing and resting echocardiography in patients with known or suspected coronary artery disease.
Subject(s)
Coronary Disease/diagnosis , Echocardiography , Exercise Test , Aged , Coronary Disease/complications , Coronary Disease/mortality , Coronary Disease/surgery , Data Interpretation, Statistical , Electrocardiography , Female , Follow-Up Studies , Heart Rate , Humans , Male , Middle Aged , Multivariate Analysis , Myocardial Infarction/etiology , Myocardial Revascularization , Prognosis , Risk , Risk Assessment , Survival Analysis , Time FactorsABSTRACT
Introducción y objetivos. Aunque la ecocardiografía de ejercicio es útil para el diagnóstico de la enfermedadcoronaria, hay menos datos referentes a su valor pronóstico. El objetivo de este estudio fue esclarecer: a) si hay un valor incremental de la ecocardiografía en el pico del ejercicio respecto a las variables clínicas, la prueba de esfuerzo y la ecocardiografía en reposo, y b) si el número y la localización de los territorios afectados, así como el tipo de respuesta al ejercicio, influyen en la estratificación. Pacientes y método. En 2.436 pacientes referidos para ecocardiografía de ejercicio se realizó un seguimiento de 2,1 ±1,5 años. Hubo 120 eventos (infarto no fatal o muerte cardiovascular) antes de la revascularización. Resultados. La ecocardiografía fue anormal en 1.203p acientes (49%). Hubo 89 eventos en pacientes con resultado anormal (7,3%) frente a 31 con resultado normal (2,5%; p < 0,001). Mediante un análisis multivariable de variables clínicas, de la prueba de esfuerzo y de la ecocardiografía en reposo y ejercicio encontramos que las variables asociadas de manera independiente con el riesgo deeventos eran: ser varón (riesgo relativo [RR] = 1,7; intervalo de confianza [IC] del 95%, 1,1-2,8; p = 0,02), los equivalentes metabólicos o MET (RR = 0,9; IC del 95%, 0,9-1,0;p = 0,01), el producto frecuencia cardíaca × presión arterial(RR = 0,9; IC del 95%, 0,9-1,0; p = 0,02), el índice de motilidad segmentaria basal (RR = 2,5; IC del 95%, 1,5-4,1; p <0,0001) y el número de territorios afectados (RR = 1,4; ICdel 95%, 1,2-1,7; p < 0,0001) (χ² final = 170, valor incremental de la ecocardiografía en el máximo esfuerzo; p <0,0001). Las mismas variables, excepto el sexo, estaban asociadas con la muerte (χ² final = 169, valor incremental de la ecocardiografía de ejercicio; p = 0,01). Conclusiones. La ecocardiografía en el máximo ejercicio incrementa el valor pronóstico de las variables clínicas, la prueba de esfuerzo y la ecocardiografía de reposo
Introduction and objectives. Exercise echocardiography (EE) is useful for diagnosing coronary disease, but little is known about its value for risk stratification. We aimed to determine: a) whether data from EE supplemented clinical data and data from exercise testing and resting echocardiography in predicting cardiac events; and b)whether the number and location of abnormal regions and their responses to exercise influenced risk stratification. Patients and method. The 2,436 patients referred for EE were followed up for 2.1±1.5 years. Some 120 serious cardiovascular events (i.e., non-fatal myocardial infarctionor cardiovascular death) occurred before revascularization. Results. In 1203 patients (49%), EE gave abnormal results. There were 89 events in patients with an abnormalresult (7.3%) and 31 in those with a normal result (2.5%; P<.0001). Multivariate analysis of clinical data, and data from exercise testing, resting echocardiography, and EE showed that male sex (RR=1.7; 95% CI, 1.1-2.8; P=.02),metabolic equivalents or METs (RR=0.9; 95% CI, 0.86-0.98; P=.01), peak heart rate × blood pressure (RR= 0.9;95% CI, 0.9; P=.002), resting wall motion score index(RR=2.5; 95% CI, 1.5-4.1; P<.0001), and number of ab-normal regions at peak exercise (RR=1.4; 95% CI, 1.2-1.7; P<.0001) were independently associated with the risk of a serious event (final model χ², 170; incremental P<.0001). The same variables, excluding sex, were independently associated with cardiovascular death (final model χ², 169; incremental P=.01). Conclusions. Exercise echocardiography supplements clinical data and data from exercise testing and resting echocardiography in patients with known or suspected coronary artery disease