title: Prediction of mortality by exercise echocardiography: a strategy for combination with the duke treadmill score.
abstract: BACKGROUND
  In studies generally involving short follow-up, exercise echocardiography has been shown to predict composite end points. We sought to study the prediction of mortality with this test and to devise a strategy for combination with standard exercise testing.
  
  
  RESULTS
  Clinical, exercise testing, and echocardiographic data were collected in 5375 patients (aged 54+/-14 years, 3880 men) undergoing exercise echocardiography. The Duke treadmill score was derived from the results of treadmill exercise testing. Resting left ventricular (LV) function and the presence and severity of ischemia were interpreted by expert observers. Follow-up at 10.6 years (mean 5.5+/-1.9 years) was complete in 5211 patients (97%). The Duke score classified 59% of patients as low risk, 39% as intermediate risk, and 2% as high risk. Resting LV dysfunction was present in 1445 patients (27%), and the exercise echocardiogram was abnormal in 2525 patients (47%). Death occurred in 649 patients (12%). Over the first 6 years of follow-up, those with normal exercise echocardiograms had a mortality of 1% per year. Ischemia was an independent predictor of mortality. In sequential Cox models, the predictive power of clinical data was strengthened by adding the Duke score, resting LV function, and the results of exercise echocardiography. Exercise echocardiography was able to substratify patients with intermediate-risk Duke scores into groups with a yearly mortality of 2% to 7%.
  
  
  CONCLUSIONS
  A normal exercise echocardiogram confers a low risk of death, and positive results are an independent predictor of death; ischemia is incremental to other data. This test may be particularly useful in patients with intermediate-risk Duke treadmill scores.
authors.affiliation: Department of Medicine, University of Queensland, Brisbane, Australia.
authors.forename: T H
authors.initials: TH
authors.lastname: Marwick
authors.forename: C
authors.initials: C
authors.lastname: Case
authors.forename: C
authors.initials: C
authors.lastname: Vasey
authors.forename: S
authors.initials: S
authors.lastname: Allen
authors.forename: L
authors.initials: L
authors.lastname: Short
authors.forename: J D
authors.initials: JD
authors.lastname: Thomas
mesh_terms: D000328:Adult; D003327:Coronary Disease / Q000401:mortality* / Q000503:physiopathology; D004452:Echocardiography / Q000379:methods*; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016019:Survival Analysis; D015996:Survival Rate