title: Prognostic value of exercise echocardiography: validation of a new risk index combining echocardiographic, treadmill, and exercise electrocardiographic parameters.
abstract: 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.
authors.affiliation: Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas 77030, USA.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Mazur
authors.forename: Jose M
authors.initials: JM
authors.lastname: Rivera
authors.forename: Alexander F
authors.initials: AF
authors.lastname: Khoury
authors.forename: Abhijeet G
authors.initials: AG
authors.lastname: Basu
authors.forename: Alejandro
authors.initials: A
authors.lastname: Perez-Verdia
authors.forename: Gary F
authors.initials: GF
authors.lastname: Marks
authors.forename: Su Min
authors.initials: SM
authors.lastname: Chang
authors.forename: Leopoldo
authors.initials: L
authors.lastname: Olmos
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Quiñones
authors.forename: William A
authors.initials: WA
authors.lastname: Zoghbi
mesh_terms: D000328:Adult; D000368:Aged; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality; D018572:Disease-Free Survival; D025401:Echocardiography, Stress; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D009204:Myocardial Revascularization; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment