Echocardiographic correlates of survival in patients with chest pain.
OBJECTIVE
This study sought to identify echocardiographic predictors of survival in patients with chest pain and to assess the utility of qualitative echocardiographic data in the prognostic stratification of this cohort.


BACKGROUND
The potential usefulness of echocardiographic data in prognostic stratification of patients with acute chest pain is unclear, in part because of the qualitative nature of routinely available echocardiographic readings.


METHODS
The study group comprised 513 patients who underwent transthoracic two-dimensional and Doppler echocardiography within 1 month of emergency department visits for acute chest pain. Clinical and electrocardiographic (ECG) data were recorded for these patients at the time of their initial evaluations, and echocardiographic data were subsequently obtained from the official hospital reports. Follow-up survival rate data were obtained from medical records or the Massachusetts Bureau of Vital Statistics.


RESULTS
A mean of 28.5 months after the index visit, 102 patients (20%) had died, including 58 (57%) for whom the primary cause of death was cardiovascular. In analysis of routinely available qualitative echocardiographic data, left ventricular size and function, the presence of regional wall motion abnormalities, mitral regurgitation and structural abnormalities of the mitral valve were significant univariate correlates of both overall mortality and death from cardiovascular causes. Severe left ventricular dysfunction (adjusted rate ratio 3.8, 95% confidence interval [CI] 1.9-7.5) and moderate or severe mitral regurgitation (adjusted rate ratio 2.4, 95% CI 1.5-3.7) were independent predictors of mortality in a multivariate Cox regression analysis that adjusted for clinical and ECG variables. Moderate or severe left ventricular dysfunction and mitral regurgitation were predictors of mortality in the subset of patients without acute myocardial infarction.


CONCLUSIONS
Qualitative echocardiographic reports of left ventricular dysfunction and mitral regurgitation were independent correlates of prognosis in patients with acute chest pain, including patients without acute myocardial infarction. Further data are needed to assess the generalizability of these findings and the implications for use of this diagnostic technology.
Fleischmann
K E
KE
Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115.
Goldman
L
L
Robiolio
P A
PA
Lee
R T
RT
Johnson
P A
PA
Cook
E F
EF
Lee
T H
TH
D000208:Acute Disease; D000328:Adult; D001900:Boston / Q000453:epidemiology; D002637:Chest Pain / Q000000981:diagnostic imaging* / Q000401:mortality*; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data; D015150:Echocardiography, Doppler / Q000706:statistics & numerical data; D004562:Electrocardiography / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality; D011379:Prognosis; D015996:Survival Rate