title: Prognostic value of exercise echocardiography in patients with atrial fibrillation.
abstract: OBJECTIVE
  Non-invasive imaging techniques for the detection of coronary artery disease (CAD) may have technical problems in patients with atrial fibrillation (AF). Although the prognostic value of exercise echocardiography (ExEcho) has been well established in several subgroups of patients, it has not yet been specifically evaluated in these patients.
  
  
  RESULTS
  From a population of 8095 patients with known or suspected CAD referred for ExEcho, 419 had AF at the time of the tests. Ischaemia was defined as the development of new or worsening wall motion abnormalities with exercise. Endpoints were hard cardiac events (i.e. cardiac death or non-fatal myocardial infarction). Mean age was 68.4 +/- 8.5 years, and 256 patients (61.1%) were men. Ischaemia was detected in 92 patients (22%). Over a mean follow-up of 3.10 +/- 2.98 years, 59 hard cardiac events occurred. The 5-year hard cardiac event rate was 37.3% in patients with ischaemia, when compared with 14.5% in patients without ischaemia (P < 0.001). In multivariate analysis, ischaemia on ExEcho remained an independent predictor of hard cardiac events (hazard ratio 1.99, 95% confidence interval 1.06-3.74, P = 0.03), and also provided incremental value over clinical, resting echocardiographic and treadmill exercise data for the prediction of hard cardiac events (P = 0.04).
  
  
  CONCLUSIONS
  ExEcho provides significant prognostic information for predicting hard cardiac events in patients with AF.
authors.affiliation: Department of Cardiology, Hospital Universitario A Coruña, As Xubias, 84, 15006 A Coruña, Spain. aboumos@canalejo.org
authors.forename: Alberto
authors.initials: A
authors.lastname: Bouzas-Mosquera
authors.forename: Jesús
authors.initials: J
authors.lastname: Peteiro
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Broullón
authors.forename: Nemesio
authors.initials: N
authors.lastname: Alvarez-García
authors.forename: Victor X
authors.initials: VX
authors.lastname: Mosquera
authors.forename: Alejandro
authors.initials: A
authors.lastname: Rodríguez-Vilela
authors.forename: Sheyla
authors.initials: S
authors.lastname: Casas
authors.forename: Alfonso
authors.initials: A
authors.lastname: Castro-Beiras
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000000981:diagnostic imaging*; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging*; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis