title: Usefulness of high functional capacity in patients with exercise-induced ST-depression to predict a negative result on exercise echocardiography and low prognostic risk.
abstract: Although exercise electrocardiography (ExECG) is commonly used to detect coronary artery disease, the diagnostic accuracy and reliability of positive (ischemic) results of ExECG in low- and intermediate-risk populations are limited. Accordingly, many patients with positive results of ExECG undergo secondary evaluation using noninvasive stress imaging such as exercise echocardiography. Functional capacity is a strong predictor of prognosis and, indirectly, of high-risk coronary artery disease. It was hypothesized that high functional capacity in patients with positive results of ExECG would predict (1) negative results on subsequent exercise echocardiography and (2) a low risk for late mortality. Results were analyzed in 104 consecutive patients (79 men, 25 women; mean age 49 years, range 27 to 76) referred for exercise echocardiography after positive results of ExECG with a treadmill workload of > or =10 METs. Late all-cause mortality was also determined in these patients. Exercise echocardiographic results were negative in 93% of patients (97 of 104; 92% of men [73 of 79] and 100% of women [25 of 25]) and positive in 7% (7 of 104). During a mean follow-up period of 7.2 +/- 1.9 years, there was 1 death. In conclusion, high functional capacity in patients with positive results of ExECG is associated with negative exercise echocardiographic results in most patients and very low late mortality. Patients with ischemic ST-segment response on ExECG who achieve workloads of > or =10 METs infrequently require additional noninvasive or invasive evaluation.
authors.affiliation: Department of Internal Medicine, University of California, Davis, Medical Center, Sacramento, California, USA.
authors.forename: Amogh
authors.initials: A
authors.lastname: Bhat
authors.forename: Amish
authors.initials: A
authors.lastname: Desai
authors.forename: Ezra A
authors.initials: EA
authors.lastname: Amsterdam
mesh_terms: D002140:California / Q000453:epidemiology; D003327:Coronary Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D018450:Disease Progression; D025401:Echocardiography, Stress / Q000379:methods*; D004562:Electrocardiography; D005080:Exercise Test / Q000009:adverse effects* / Q000379:methods; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends