Document Detail

Prediction of mortality and major cardiac events by exercise echocardiography in patients with normal exercise electrocardiographic testing.
MedLine Citation:
PMID:  19460612     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: We sought to assess the value of exercise echocardiography (EE) for predicting outcome in patients with known or suspected coronary artery disease and normal exercise electrocardiogram (ECG) testing. BACKGROUND: The prognostic value of EE in patients with normal exercise ECG testing has not been characterized. METHODS: We studied 4,004 consecutive patients (2,358 men, mean age [+/- SD] 59.6 +/- 12.5 years) with interpretable ECG who underwent treadmill EE and did not develop chest pain or ischemic ECG abnormalities during the tests. Wall motion score index (WMSI) was evaluated at rest and with exercise, and the difference (DeltaWMSI) was calculated. Ischemia was defined as the development of new or worsening wall motion abnormalities with exercise. End points were all-cause mortality and major cardiac events (MACE). RESULTS: Overall, 669 patients (16.7%) developed ischemia with exercise. During a mean follow-up of 4.5 +/- 3.4 years, 313 patients died, and 183 patients had a MACE before any revascularization procedure. The 5-year mortality and MACE rates were 6.4% and 4.2% in patients without ischemia versus 12.1% and 10.1% in those with ischemia, respectively (p < 0.001). In the multivariate analysis, DeltaWMSI remained an independent predictor of mortality (hazard ratio [HR]: 2.73, 95% confidence interval [CI]: 1.40 to 5.32, p = 0.003) and MACE (HR: 3.59, 95% CI: 1.42 to 9.07, p = 0.007). The addition of the EE results to the clinical, resting echocardiographic and exercise hemodynamic data significantly increased the global chi-square of the models for the prediction of mortality (p = 0.005) and MACE (p = 0.009). CONCLUSIONS: The use of EE provides significant prognostic information for predicting mortality and MACE in patients with interpretable ECG and normal exercise ECG testing.
Alberto Bouzas-Mosquera; Jesús Peteiro; Nemesio Alvarez-García; Francisco J Broullón; Victor X Mosquera; Lourdes García-Bueno; Luis Ferro; Alfonso Castro-Beiras
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  53     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-05-22     Completed Date:  2009-06-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1981-90     Citation Subset:  AIM; IM    
Department of Cardiology, Hospital Universitario A Coruña, A Coruña, Spain.
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MeSH Terms
Coronary Artery Disease / mortality*,  physiopathology,  ultrasonography
Death, Sudden, Cardiac / epidemiology,  prevention & control*
Echocardiography, Stress / methods*
Follow-Up Studies
Middle Aged
Predictive Value of Tests
Retrospective Studies
Risk Factors
Spain / epidemiology
Survival Rate / trends
Comment In:
J Am Coll Cardiol. 2009 May 26;53(21):1991-2   [PMID:  19460613 ]

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