title: Incremental prognostic value of stress echo positivity in the left anterior descending coronary artery territory.
abstract: BACKGROUND
  Dipyridamole stress echo (DSE) positivity is usually titrated according to presence and severity of the induced wall motion abnormalities. The purpose of our study is to assess whether the location of DSE positivity might add to prognostic stratification.
  
  
  METHODS
  The study enrolled 112 patients with known or suspected coronary artery disease (CAD) and without a history of prior myocardial infarction. They were consecutively submitted to DSE (0.84 mg/Kg in 10 min followed by atropine administration, when needed) and coronary angiography (within a 15+/-7 day period). End points at follow-up were cardiac death and acute coronary syndromes.
  
  
  RESULTS
  Twenty-seven patients had a negative, and 85 a positive DSE (47 in the LAD territory). Angiographically assessed CAD was present in 82 patients (LAD in 59). At a follow-up of 9+/-7 months, there were 28 events of cardiac deaths or acute coronary syndromes. Event-free survival was lower in patients with positive DSE (any location) compared to those with negative DSE (47% vs 89%, p=0.003). In the subset with positive DSE, event-free survival was lower in patients with wall motion abnormalities in the LAD territory compared to those with dysfunction in the left circumflex and right coronary artery territory (31% vs 72%, p=0.00012 ). At multivariate analysis, stress echo positivity in the LAD territory was independently associated with increased risk (HR: 9.51, CI: 1.61 to 56.11, p<0.013) and outperformed angiographically assessed LAD stenosis (HR: 0.36, CI: 0.06 to 2.24, p: NS).
  
  
  CONCLUSIONS
  In CAD patients, wall motion abnormalities in the LAD territory during DSE identified a higher risk subgroup. Functional stress echo positivity on the LAD territory overcame the prognostic impact of an anatomic, angiographically assessed LAD disease.
authors.affiliation: Cardiovascular Unit-Civil Hospital, Viale Vittorio Alfieri, 36, 57124, Livorno, Italy. umbertobaldini@hotmail.com
authors.forename: Umberto
authors.initials: U
authors.lastname: Baldini
authors.forename: Frank Lloyd
authors.initials: FL
authors.lastname: Dini
authors.forename: Maurizio
authors.initials: M
authors.lastname: Raugi
authors.forename: Alberto
authors.initials: A
authors.lastname: Genovesi-Ebert
mesh_terms: D000328:Adult; D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality; D004176:Dipyridamole; D025401:Echocardiography, Stress; D006801:Humans; D008875:Middle Aged; D011379:Prognosis
chemical_list: D004176:Dipyridamole