title: Prognostic significance of baseline ST-T-wave abnormalities in diagnostic stress echocardiography.
abstract: OBJECTIVE
  The aim of this study was to determine whether resting ST-T wave abnormalities (ST-Ta) provide incremental prognostic information in patients with no history of coronary artery disease undergoing dobutamine stress echocardiography (DSE).
  
  
  METHODS
  We evaluated 1308 consecutive patients without previous myocardial infarction (MI) or revascularization who underwent DSE. Ischemia was defined as new or worsening wall motion abnormalities. End points during follow-up were all-cause death and cardiac death/nonfatal MI.
  
  
  RESULTS
  ST-Ta were detected in 162 (12%) patients. The incidence of ischemia was higher in patients with baseline ST-Ta than patients without [74 (46%) vs. 327 (28%), P=0.00001]. During a follow-up of 4.6 ± 3 years, cardiac death/nonfatal MI occurred in 42 (26%) patients with resting ST-Ta and in 157 (14%) patients without resting ST-Ta (P<0.001). Patients with ST-Ta had a higher annual cardiac death/nonfatal MI rate compared with patients without, both in the presence of normal DSE (3.2 vs. 1.4%, P=0.01) as well as abnormal DSE (5.3 vs. 3%, P<0.001). In a Cox proportional modeling, resting ST-Ta added incremental value over clinical and stress echocardiographic data for the prediction of death (global χ 125, 140, 150, respectively; P<0.05) and cardiac death/nonfatal MI (global χ 79, 100, 111, respectively; P<0.05).
  
  
  CONCLUSIONS
  Baseline ST-Ta are associated with an increased risk of cardiac death/nonfatal MI and all-cause mortality, incremental to clinical data and DSE results. The associated risk is persistent among patients with normal DSE.
authors.affiliation: Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands. chiarapedone@yahoo.it
authors.forename: Chiara
authors.initials: C
authors.lastname: Pedone
authors.forename: Abdou
authors.initials: A
authors.lastname: Elhendy
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: Stefan P
authors.initials: SP
authors.lastname: Nelwan
authors.forename: Elena
authors.initials: E
authors.lastname: Biagini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Pasquale
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D025401:Echocardiography, Stress; D004562:Electrocardiography; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology* / Q000401:mortality; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D009426:Netherlands; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors