Simple six-item clinical score improves risk prediction capability of stress echocardiography
Lauro Cortigiani1, Clara Carpeggiani2, Rosa Sicari2
1Division of Cardiology, San Luca Hospital, Lucca, Italy.
Insights
A new risk score using simple clinical factors effectively predicts mortality in patients undergoing stress echocardiography (SE). This score enhances risk stratification beyond traditional ischemia assessment in coronary artery disease evaluation.
Area of Science:
- Cardiology
- Echocardiography
- Risk Stratification
Background:
- Stress echocardiography (SE) is crucial for evaluating coronary artery disease (CAD).
- Current risk stratification in SE primarily focuses on ischemia.
- There is a need to integrate non-ischemic factors for improved prognostic power.
Purpose of the Study:
- To develop and validate a simple risk score using non-ischemia-related variables.
- To assess the score's ability to enhance risk stratification during SE.
- To determine the score's prognostic value in predicting all-cause mortality.
Main Methods:
- A large cohort of 14,279 patients undergoing SE for CAD evaluation was analyzed.
- Patients were divided into modeling and validation groups.
- Multivariate analysis identified independent predictors of mortality, forming a risk score.
Main Results:
- Ischemia during SE and six non-ischemic factors (age, rest wall motion, diabetes, LBBB, anti-ischemic therapy, male sex) predicted mortality.
- The developed risk score was prognostically effective in both modeling and validation groups.
- The risk score was the sole independent predictor of mortality alongside ischemia in SE.
Conclusions:
- Simple clinical variables can be integrated into a score to optimize SE risk stratification.
- This score improves the prediction of mortality in patients undergoing SE.
- The findings support the use of this simple score for enhanced risk assessment in CAD.
Objectives:
To assess the value of a simple score integrating non-ischaemia-related variables in expanding the wall motion abnormalities risk power during stress echocardiography (SE).
Methods:
Study includes 14 279 patients who underwent SE for evaluation of coronary artery disease. All-cause death was the end point. Patients were randomly divided into the modelling and validation group of equal size. In the modelling group, multivariate analysis was conducted using clinical, rest and SE data, and a score was obtained from the number of non-ischaemia-related independent prognostic predictors. The score prognostic capability was compared in both groups.
Results:
During a median follow-up of 31 months, 1230 patients died: 622 (9%) in the modelling and 608 (9%) in the validation group (p=0.68). Independent predictors of mortality were ischaemia at SE (HR 1.77, 95% CI 1.49 to 2.12; p<0.0001) and six other parameters: age>65 years, wall motion at rest, diabetes, left bundle branch block, anti-ischaemic therapy and male sex. Risk score resulted prognostically effective in the modelling and validation groups, both with and without inducible ischaemia subset. When risk score was included in the multivariate analysis, besides ischaemia at SE it was the only independent predictor of mortality in the modelling (HR 1.70, 95% CI 1.60 to 1.82; p<0.0001), in the validation (HR 1.77, 95% CI 1.65 to 1.90; p<0.0001) and in the overall group (HR 1.73, 95% CI 1.66 to 1.82; p<0.0001).
Conclusions:
Simple clinical variables may be able to optimise SE risk stratification.
Related Concept Videos
01:26Exercise Stress Test
Exercise stress testing, commonly known as a treadmill test, is a noninvasive procedure used to evaluate cardiovascular function and diagnose heart conditions.
Definition
An exercise stress test measures the heart's response to exertion using a treadmill or stationary bicycle. Chest electrodes record the heart's electrical activity through an ECG, and blood pressure is monitored regularly.
Purposes
01:17Imaging Studies for Cardiovascular System I:Echocardiography
Indications: Echocardiography is utilized to diagnose heart failure, valve disorders, and myocardial infarction. It also assesses cardiac structures' size, shape, and motion, evaluates...
01:20Imaging Studies for Cardiovascular System II:Types of Echocardiography
Types of Echocardiography
Transthoracic Echocardiography (TTE)
TTE is the most common type of echocardiogram which involves placing a transducer on the patient's chest, emitting sound waves to create heart images. TTE is invaluable for evaluating the heart's size, structure, and motion, making it particularly useful for diagnosing...
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:29Cardiomyopathy VI: Nursing Management