Document Detail

Prognostic value of exercise echocardiography: validation of a new risk index combining echocardiographic, treadmill, and exercise electrocardiographic parameters.
MedLine Citation:
PMID:  12712013     Owner:  NLM     Status:  MEDLINE    
Exercise (Ex) echocardiography has been shown to have significant prognostic power, independent of other known predictors of risk from an Ex stress test. The purpose of this study was to evaluate a risk index, incorporating echocardiographic and conventional Ex variables, for a more comprehensive risk stratification and identification of a very low-risk group. Two consecutive, mutually exclusive populations referred for treadmill Ex echocardiography with the Bruce protocol were investigated: hypothesis-generating (388 patients; 268 males; age 55 +/- 13 years) and hypothesis-testing (105 patients; 61 males age: 54 +/- 14 years).Cardiac events included cardiac death, myocardial infarction, late revascularization (>90 days), hospital admission for unstable angina, and admission for heart failure. Mean follow-up in the hypothesis-generating population was 3.1 years. There were 38 cardiac events. Independent predictors of events by multivariate analysis were: Ex wall motion score index (odds ratio [OR] = 2.77/Unit; P <.001); ischemic S-T depression > or = 1 mm (OR = 2.84; P =.002); and treadmill time (OR = 0.87/min; P =.037). A risk index was generated on the basis of the multivariate Cox regression model as: risk index = 1.02 (Ex wall motion score index) + 1.04 (S-T change) - 0.14 (treadmill time). The validity of this index was tested in the hypothesis-testing population. Event rates at 3 years were lowest (0%) in the lower quartile of risk index (-1.22 to -0.47), highest (29.6%) in the upper quartile (+0.66 to +2.02), and intermediate (19.2% to 15.3%) in the intermediate quartiles. The OR of the risk index for predicting cardiac events was 2.94/Unit ([95% confidence interval: 1.4 to 6.2]; P =.0043). Echocardiographic and Ex parameters are independent powerful predictors of cardiac events after treadmill stress testing. A risk index can be derived with these parameters for a more comprehensive risk stratification with Ex echocardiography.
Wojciech Mazur; Jose M Rivera; Alexander F Khoury; Abhijeet G Basu; Alejandro Perez-Verdia; Gary F Marks; Su Min Chang; Leopoldo Olmos; Miguel A Quiñones; William A Zoghbi
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Publication Detail:
Type:  Journal Article; Validation Studies    
Journal Detail:
Title:  Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography     Volume:  16     ISSN:  0894-7317     ISO Abbreviation:  J Am Soc Echocardiogr     Publication Date:  2003 Apr 
Date Detail:
Created Date:  2003-04-24     Completed Date:  2003-09-16     Revised Date:  2009-11-03    
Medline Journal Info:
Nlm Unique ID:  8801388     Medline TA:  J Am Soc Echocardiogr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  318-25     Citation Subset:  IM    
Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas 77030, USA.
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MeSH Terms
Coronary Artery Disease / complications,  mortality,  ultrasonography*
Disease-Free Survival
Echocardiography, Stress*
Exercise Test*
Follow-Up Studies
Health Status Indicators
Middle Aged
Myocardial Infarction / etiology
Myocardial Revascularization
Prospective Studies
Risk Assessment

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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