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Prognostic usefulness of positive or negative exercise stress echocardiography for predicting coronary events in
J Krivokapich1, J S Child, R S Gerber
1Department of Medicine, UCLA School of Medicine 90024-1679.
Insights
Exercise stress echocardiography effectively predicts cardiac events. A positive test indicates a threefold increased risk of cardiac events and a fourfold increased risk of myocardial infarction within 12 months.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Preventive Cardiology
Background:
- Stress echocardiography is a key diagnostic tool for myocardial ischemia in patients with coronary artery disease.
- Evaluating the prognostic value of stress echocardiography in relation to cardiac events is crucial for patient management.
Purpose of the Study:
- To assess the correlation between exercise stress echocardiography results and cardiac event rates within 12 months.
- To determine the predictive value of stress echocardiography for myocardial infarction and other cardiac events.
Main Methods:
- A cohort of 360 patients referred for suspected myocardial ischemia underwent exercise stress echocardiography.
- Cardiac events (myocardial infarction, revascularization, death) were tracked for 12 months post-testing.
- Analysis compared event rates between patients with positive and negative stress echocardiograms.
Main Results:
- A positive stress echocardiogram (new/worsened wall motion abnormalities) was found in 18% of patients.
- Patients with a positive test had a 34% cardiac event rate versus 9% with a negative test.
- A positive stress echocardiogram was associated with a threefold increased risk of any cardiac event and a fourfold increased risk of myocardial infarction.
Conclusions:
- Stress echocardiography is a valuable predictor of short-term cardiac events in patients with suspected ischemia.
- Combining stress echocardiography with electrocardiography may enhance predictive accuracy.
- A positive stress echocardiogram warrants close follow-up and consideration for intervention.
Abstract:
Stress echocardiography is useful in diagnosing myocardial ischemia in patients with significant coronary artery disease. This study examines the correlation between the results of exercise stress echocardiography and cardiac event rates within 12 months after testing in patients referred for evaluation of possible myocardial ischemia. Cardiac events, defined as myocardial infarction, coronary artery bypass surgery, percutaneous transluminal coronary angioplasty or death, were tabulated for 360 patients with > or = 12 months of follow-up, or a cardiac event within 12 months of follow-up, or both. Wall motion abnormalities at rest were present in 60% of patients. A positive stress echocardiogram, defined as the development of new or worsened wall motion abnormalities, was obtained in 18% of patients (65 of 360), and > or = 1 cardiac event during follow-up was present in 14% (n = 49). A cardiac event occurred in 34% of patients (22 of 65) with a positive stress echocardiogram and in 9% (27 of 295) with a negative one. Myocardial infarctions occurred in 9% of patients with a positive stress echocardiogram compared with 2% with a negative test. An insufficient exercise capacity to reliably exclude ischemia was present in 63% of patients (17 of 27) with a cardiac event despite a negative stress echocardiogram. The predictive value of the stress echocardiographic results was enhanced by combining these results with the electrocardiographic results. In summary, a positive stress echocardiogram was associated with a threefold increased incidence of any cardiac event, and a fourfold increased incidence of myocardial infarction within 12 months of follow-up compared with a negative stress echocardiogram.(ABSTRACT TRUNCATED AT 250 WORDS)