Outcome by Exercise Echocardiography in Patients with Low Pretest Probability of Coronary Artery Disease
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Updated: Mar 22, 2026
Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
Jesus Peteiro1, Alberto Bouzas-Mosquera1, Javier Broullon2
1Department of Cardiology, Complejo Hospitalario Universitario de A Coruña, Instituto de Investigacion Biomedica de A Coruña and Universidad de A Coruña, A Coruña, Spain.
Insights
Exercise echocardiography (ExE) provides limited prognostic value for patients with a low pretest probability of coronary artery disease. Few abnormal findings and low event rates reduce the utility of ExE in this population.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Preventive Cardiology
Background:
- Guidelines differ on testing strategies for patients with low pretest probability of coronary artery disease.
- The prognostic value of exercise echocardiography (ExE) in this specific patient group remains unclear.
Purpose of the Study:
- To assess the diagnostic and prognostic value of ExE in patients with a low pretest probability of coronary artery disease (<15%).
Main Methods:
- Retrospective analysis of 1,436 patients undergoing ExE with low pretest coronary artery disease probability.
- Assessment of all-cause mortality, major adverse cardiac events (MACE), and revascularization rates during follow-up.
- Measurement of exercise-induced ischemia and resting/fixed wall motion abnormalities.
Main Results:
- Low rates of resting abnormalities (0.9%) and ischemia (7.5%) were observed.
- Annualized rates for cardiac death (0.39%), MACE (0.21%), and revascularization (0.51%) were low.
- No significant difference in MACE rates or annualized MACE rates between patients with normal and abnormal ExE findings (P=.70).
Conclusions:
- ExE offers limited prognostic information in patients with low pretest probability of coronary artery disease.
- The low prevalence of abnormal findings and low event rates diminish the clinical utility of ExE in this population.
- A high number of tests are required to identify significant abnormalities, further limiting ExE's value.
Background:
Recommendations for testing in patients with low pretest probability of coronary artery disease differ in guidelines from no testing at all to different tests. The aim of this study was to assess the value of exercise echocardiography (ExE) to define outcome in this population.
Methods:
A retrospective analysis was conducted of 1,436 patients with low pretest probability of coronary artery disease (<15%) who underwent initial ExE. Overall mortality, major adverse cardiac events (MACEs), defined as cardiac death or nonfatal myocardial infarction, and revascularization during follow-up, were assessed. Ischemia (development of new wall motion abnormalities with exercise) and fixed wall motion abnormalities were measured.
Results:
The mean age was 50 ± 12 years. Resting wall motion abnormalities were seen in 13 patients (0.9%) and ischemia in 108 (7.5%). During follow-up, 38 patients died, 10 of cardiac death (annualized death rate, 0.39%); 20 patients had MACEs (annualized MACE rate, 0.21%); and 48 patients (29 with ischemia) underwent revascularization (annualized revascularization rate, 0.51%). The number and percentage of MACEs in the abnormal and normal ExE groups were similar (two [1.7%] vs 18 [1.4%], P = .70), as was the annualized MACE rate (0.31% vs 0.21%, P = .50). Peak left ventricular ejection fraction exhibited a nonsignificant trend for predicting MACEs (P = .11). The number of studies needed to detect an abnormal finding was 12.6 and to detect a patient with extensive ischemia was 26.1.
Conclusions:
ExE offers limited prognostic information in patients with low pretest probability of coronary artery disease. The small number of abnormal findings on ExE and low event rates and the large number of studies needed to detect an abnormal finding limit further the value of imaging in this population.
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