title: Risk stratification and prognosis in octogenarians undergoing stress echocardiographic study.
abstract: BACKGROUND
  The prognostic value of stress echocardiography (SE) for the diagnosis and risk stratification of coronary artery disease in octogenarians is not well defined.
  
  
  METHODS
  Follow-up of 5 years (mean 2.9 +/- 1.0 years) for confirmed nonfatal myocardial infarction (n = 17) and cardiac death (n = 37) was obtained in 335 patients, age > or =80 years (mean age 84 +/- 3 years, 44% male), undergoing SE (33% treadmill, 67% dobutamine). Left ventricular (LV) regional wall motion was assessed by a consensus of two echocardiographers and scored as per standard five-point scale, 16-segment model of wall motion analysis. Ischemic LV wall segment was defined as deterioration in the thickening and excursion during stress (increase in wall-motion score index (WMSI) > or =1).
  
  
  RESULTS
  By univariate analysis, inducible ischemia (chi-square = 38.4, P < 0.001), left ventricular ejection fraction (chi-square = 41.2, P < 0.001), a history of previous myocardial infarction (chi-square = 22.3, P < 0.01), hypertension (chi-square = 33, P < 0.01), and age (chi-square = 27.7, P < 0.01) were significant predictors of future cardiac events. WMSI, an index of inducible ischemia, provided incremental prognostic information when forced into a multivariable model where clinical and rest echocardiography variables were entered first. WMSI effectively stratified octogenarians into low- and high-risk groups (annualized event rates of 1.2 versus 5.8%/year, P < 0.001).
  
  
  CONCLUSIONS
  Stress echocardiography yields incremental prognostic information in octogenarians and effectively stratifies them into low- and high-risk groups. Precise therapeutic decision making in very elderly patients should incorporate combined clinical and stress echocardiography data.
authors.affiliation: Department of Medicine, Division of Cardiology, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, 1111 Amsterdam Avenue, New York, NY 10025, USA. fchaudhry@chpnet.org
authors.forename: Farooq A
authors.initials: FA
authors.lastname: Chaudhry
authors.forename: Ehtasham A
authors.initials: EA
authors.lastname: Qureshi
authors.forename: Siu-Sun
authors.initials: SS
authors.lastname: Yao
authors.forename: Sripal
authors.initials: S
authors.lastname: Bangalore
mesh_terms: D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D025401:Echocardiography, Stress; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment