Risk stratification by treadmill exercise echocardiography in patients with excellent exercise capacity.
BACKGROUND
The incremental value of exercise echocardiography (EE) has been demonstrated to be maximal in patients with moderate pretest probability for coronary artery disease, but there is a lack of data in patients with low pretest probability or patients with good functional capacity.


METHODS
To investigate whether such incremental value is maintained in patients with excellent exercise capacity, we studied 1,433 patients who had excellent exercise capacity (>or=8 METs for women, >or=10 METs for men).


RESULTS
During a follow-up of 2.3 +/- 1.5 years, 42 hard events occurred (cardiac death or nonfatal myocardial infarction). Variables independently associated to hard events were male gender (P = 0.04), % of the age-predicted maximum heart rate (P = 0.02), chronotropic reserve (P = 0.002), and abnormal EE (P = 0.03; incremental P value of EE = 0.03).


CONCLUSIONS
EE has incremental value over clinical variables, resting echocardiography, and exercise testing variables in patients with excellent exercise capacity. EE may be preferable to ECG exercise testing even in patients expected to have good exercise capacity.
Peteiro
Jesús
J
Unit of Echocardiography and Department of Cardiology, Juan Canalejo Hospital, University of A Coruña, A Coruña, Spain. pete@canalejo.org
Monserrrat
Lorenzo
L
Bouzas
Beatriz
B
Mariñas
Javier
J
Castro-Beiras
Alfonso
A
D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology* / Q000601:surgery; D018572:Disease-Free Survival; D025401:Echocardiography, Stress; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology; D009204:Myocardial Revascularization; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D012107:Research Design; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D013030:Spain; D013318:Stroke Volume