Accuracy and prognostic value of arm-exercise stress echocardiography for coronary disease

Exercise stress echocardiography (ExSEC) is a well-established modality for evaluating coronary artery disease (CAD). In individuals with lower limb impairments, arm exercise stress echocardiography (Arm-ExSEC) represents a potential alternative; however, data supporting its predictive value are lacking. This study aimed to assess the diagnostic and prognostic utility of Arm-ExSEC for CAD detection in this population. A retrospective analysis was conducted on 68 patients with lower limb disabilities (47% male; mean age 67.6 ± 10.6 years) to evaluate the ability of Arm-ExSEC to detect CAD, as confirmed by coronary angiography, and to predict a composite outcome of myocardial infarction and cardiac mortality at 1-year follow-up. Arm-ExSEC demonstrated a sensitivity of 72%, specificity of 80%, and an overall accuracy of 76% for detecting CAD. Survival analysis showed a higher incidence of the primary outcome among patients with positive Arm-ExSEC compared to those with negative results (log-rank test, p = 0.007). In multivariable Cox-regression analysis adjusted for age and sex, a positive Arm-ExSEC remained independently associated with the primary outcome (hazard ratio [95% CI], 10.50 [1.20-91.93]; p = 0.034). These findings suggest that Arm-ExSEC may serve as a valuable modality for both the diagnostic and prognostic assessment of CAD in patients with lower limb impairments.