title: Value of exercise echocardiography for predicting mortality in elderly patients.
abstract: BACKGROUND
  Elderly patients with suspected or known coronary artery disease are often referred for pharmacological stress testing. Data on the value of exercise echocardiography (ExEcho) for predicting outcome (particularly all-cause mortality) in these patients are scarce.
  
  
  METHODS
  Peak treadmill ExEcho was performed in 2159 patients ≥ 70 years of age with known or suspected coronary artery disease. Left ventricular wall motion was evaluated at baseline and with exercise, and the increase in wall motion score index from rest to peak exercise (ΔWMSI) was calculated. Ischaemia was diagnosed when new or worsening wall motion abnormalities developed with exercise. The end points were all-cause mortality and major cardiac events (cardiac death or myocardial infarction).
  
  
  RESULTS
  Ischaemia developed in 844 patients (38·6%) during exercise. Over a mean follow-up of 3·5 ± 3·1 years, 439 deaths occurred. The cumulative 5-year mortality rate was 29·3% in patients with ischaemia versus 16·8% in those without ischaemia (P < 0·001). After covariate adjustment, ΔWMSI remained an independent predictor of mortality [hazard ratio (HR) 2·37, 95% confidence interval (CI) 1·66-3·39, P < 0·001] and major cardiac events (HR 3·48, 95% CI 2·11-5·74, P < 0·001). These results remained significant even in patients with chronotropic incompetence. When added to a model with clinical, resting echocardiographic and exercise electrocardiogram variables, ExEcho results provided incremental value for the prediction of both end points (P < 0·001).
  
  
  CONCLUSIONS
  ExEcho is feasible in elderly patients with suspected or known coronary artery disease and provides useful information for risk stratification in these patients.
authors: Department of Cardiology, Hospital Universitario A Coruña, A Coruña, Spain. aboumos@canalejo.org
authors: Alberto
authors: A
authors: Bouzas-Mosquera
authors: Jesús
authors: J
authors: Peteiro
authors: Francisco J
authors: FJ
authors: Broullón
authors: Nemesio
authors: N
authors: Álvarez-García
authors: Elizabet
authors: E
authors: Méndez
authors: Alberto
authors: A
authors: Pérez
authors: Victor X
authors: VX
authors: Mosquera
authors: Alfonso
authors: A
authors: Castro-Beiras
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality*; D025401:Echocardiography, Stress; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis; D017202:Myocardial Ischemia / Q000175:diagnosis; D011379:Prognosis; D012306:Risk; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000401:mortality*