[Prognostic value of treadmill exercise echocardiography].
OBJECTIVE
Exercise echocardiography (EE) is useful for diagnosing coronary disease, but little is known about its value for risk stratification. We aimed to determine: a) whether data from EE supplemented clinical data and data from exercise testing and resting echocardiography in predicting cardiac events; and b)whether the number and location of abnormal regions and their responses to exercise influenced risk stratification.


METHODS
The 2,436 patients referred for EE were followed up for 2.1+/-1.5 years. Some 120 serious cardiovascular events (i.e., non-fatal myocardial infarction or cardiovascular death) occurred before revascularization.


RESULTS
In 1203 patients (49%), EE gave abnormal results. There were 89 events in patients with an abnormal result (7.3%) and 31 in those with a normal result (2.5%; P<.0001). Multivariate analysis of clinical data, and data from exercise testing, resting echocardiography, and EE showed that male sex (RR=1.7; 95% CI, 1.1-2.8; P=.02), metabolic equivalents or METs (RR=0.9; 95% CI, 0.86-0.98; P=.01), peak heart rate x blood pressure (RR= 0.9;95% CI, 0.9; P=.002), resting wall motion score index (RR=2.5; 95% CI, 1.5-4.1; P<.0001), and number of abnormal regions at peak exercise (RR=1.4; 95% CI, 1.2-1.7; P<.0001) were independently associated with the risk of a serious event (final model chi2, 170; incremental P<.0001). The same variables, excluding sex, were independently associated with cardiovascular death (final model chi2, 169; incremental P=.01).


CONCLUSIONS
Exercise echocardiography supplements clinical data and data from exercise testing and resting echocardiography in patients with known or suspected coronary artery disease.
Peteiro-Vázquez
Jesús
J
Servicio de Cardiología, Hospital Juan Canalejo, A Coruña, Spain. pete@canalejo.org
Monserrrat-Iglesias
Lorenzo
L
Mariñas-Davila
Javier
J
Garrido-Bravo
Iris P
IP
Bouzas-Caamaño
María
M
Muñiz-García
Javier
J
Bouzas-Mosquera
Alberto
A
Bouzas-Zubeldia
Beatriz
B
Alvarez-García
Nemesio
N
Castro-Beiras
Alfonso
A
D000368:Aged; D003327:Coronary Disease / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D003627:Data Interpretation, Statistical; D004452:Echocardiography; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology; D009204:Myocardial Revascularization; D011379:Prognosis; D012306:Risk; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors