Document Detail

Prognostic value of peak and post-exercise treadmill exercise echocardiography in patients with known or suspected coronary artery disease.
MedLine Citation:
PMID:  19825812     Owner:  NLM     Status:  MEDLINE    
AIMS: Although peak may have higher sensitivity than post-treadmill exercise echocardiography (EE) for the detection of coronary artery disease (CAD), its prognostic value remains unknown. We sought to assess the relative values of peak and post-EE for predicting outcome in patients with known/suspected CAD.
METHODS AND RESULTS: We studied 2947 patients who underwent EE. Wall motion score index (WMSI) was evaluated at rest, peak, and post-exercise. Ischaemia was defined as the development of new or worsening wall motion abnormalities with exercise. Separate analyses for all-cause mortality and major cardiac events (MACE) were performed. Ischaemia developed in 544 patients (18.5%). Among them, ischaemia was detected only at peak exercise in 124 patients (23%), whereas 414 (76%) had ischaemia at peak plus post-exercise imaging and six patients (1%) had ischaemia only at post-exercise. During follow-up, 164 patients died. The 5-year mortality rate was 3.5% in patients without ischaemia, 15.3% in patients with peak ischaemia alone, and 14% in patients with post-exercise ischaemia (P < 0.001 normal vs. ischaemic groups). In the multivariate analysis, post-exercise WMSI was an independent predictor of MACE [hazard ratio (HR) 1.87, 95% confidence interval (CI) 1.09-2.19, P = 0.02]. Peak exercise WMSI was an independent predictor of MACE (HR 2.19, 95% CI 1.30-3.69, P = 0.003) and mortality (HR 1.58, 95% CI 1.07-2.35, P = 0.02). The addition of peak EE results to clinical, resting echocardiography, exercise variables, and post-EE provided incremental prognostic information for MACE (P = 0.04) and mortality (P = 0.04).
CONCLUSION: Peak treadmill EE provides significant incremental information over post-EE for predicting outcome in patients with known or suspected CAD.
Jesús Peteiro; Alberto Bouzas-Mosquera; Francisco J Broullón; Ana Garcia-Campos; Pablo Pazos; Alfonso Castro-Beiras
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-10-12
Journal Detail:
Title:  European heart journal     Volume:  31     ISSN:  1522-9645     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-01-15     Completed Date:  2011-01-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  187-95     Citation Subset:  IM    
Department of Cardiology, Complejo Hospitalario Universitario de A Coruña, As Xubias 84, A Coruña, Spain.
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MeSH Terms
Coronary Artery Disease / mortality*,  ultrasonography
Echocardiography, Stress / mortality
Exercise / physiology*
Exercise Test / methods
Follow-Up Studies
Middle Aged
Myocardial Ischemia / mortality,  ultrasonography
Observer Variation

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