Document Detail

Comparison of prognostic value of stress echocardiography versus stress electrocardiography in patients with suspected coronary artery disease.
MedLine Citation:
PMID:  16125483     Owner:  NLM     Status:  MEDLINE    
Stress electrocardiographic (ECG) ST-segment depression is a prognostic marker of adverse cardiac outcomes in coronary artery disease. However, use of concurrent stress echocardiography (ECHO) has lead to concordant and discordant findings on stress electrocardiogram during stress studies. The prognostic value of stress ECHO in the setting of these stress ECG findings has not been previously evaluated. Outcomes of 1,268 patients (60 +/- 12 years old, 48% women) who had normal electrocardiograms and underwent stress ECHO were analyzed. ST-segment depression > or =1.5 mm in 2 contiguous leads on stress electrocardiogram and a wall motion score index of >1 on peak stress echocardiogram were considered abnormal. Events of nonfatal myocardial infarction (n = 18) and cardiac death (n = 32) were analyzed during follow-up (2.8 +/- 0.9 years). In 91 patients (7%) who had abnormal findings on stress electrocardiogram, 38 (41%) had an abnormal finding on stress echocardiogram and 4 had cardiac events (0.6% per year), and all who had a normal finding on stress echocardiogram had no events (n = 53, 59%, p = 0.01). Among 46 events (92%) with a normal finding on stress electrocardiogram, 30 (60%) showed a discordantly abnormal finding on stress echocardiogram (3.2% per year, p <0.01). Overall, the cohort that had normal findings on stress echocardiogram showed a lower event rate (72%, 16 events, 1.1% per year) compared with the cohort that had abnormal findings on stress echocardiogram (28%, 34 events, 3.6% per year, p <0.001), independent of stress ECG response. Peak wall motion score index (hazard ratio 2.55, p <0.001) and left ventricular ejection fraction (hazard ratio 0.99, p <0.001) were independent and incremental (global chi-square, p <0.001) prognostic markers by stress ECHO. In conclusion, a normal finding on stress echocardiogram confers a benign prognosis independent of the type of stress ECG response during stress studies. In addition, peak wall motion score index and ejection fraction by ECHO are stronger prognostic markers over stress electrocardiography in patients who are evaluated for coronary artery disease.
Jo Mahenthiran; Sripal Bangalore; Siu-Sun Yao; Farooq A Chaudhry
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The American journal of cardiology     Volume:  96     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2005 Sep 
Date Detail:
Created Date:  2005-08-29     Completed Date:  2005-10-06     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  628-34     Citation Subset:  AIM; IM    
St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York, USA.
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MeSH Terms
Aged, 80 and over
Cardiotonic Agents / administration & dosage,  diagnostic use
Coronary Disease / diagnosis*,  physiopathology
Dobutamine / administration & dosage,  diagnostic use
Echocardiography, Stress*
Exercise Test / methods*
Follow-Up Studies
Injections, Intravenous
Middle Aged
Predictive Value of Tests
Proportional Hazards Models
Retrospective Studies
Stroke Volume
Reg. No./Substance:
0/Cardiotonic Agents; 34368-04-2/Dobutamine

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