title: Stress echocardiography and major cardiac events in patients with normal exercise test.
abstract: BACKGROUND
  Exercise test (ET) is the preferred initial noninvasive test for the diagnosis and risk stratification of coronary artery disease (CAD), however, its lower sensitivity may fail to identify patients at greater risk of adverse events.
  
  
  OBJECTIVE
  To assess the value of stress echocardiography (SE) for predicting all-cause mortality and major cardiac events (MACE) in patients with intermediate pretest probability of CAD and a normal ET.
  
  
  METHODS
  397 patients with intermediate CAD pretest probability , estimated by the Morise score, and normal ET who underwent SE were studied. The patients were divided into two groups according to the absence (G1) or presence (G2) of myocardial ischemia on SE .End points evaluated were all-cause mortality and MACE, defined as cardiac death and nonfatal acute myocardial infarction (AMI).
  
  
  RESULTS
  G1 group was comprised of 329 (82.8%) patients. The mean age of the patients was 57.37 ± 11 years and 44.1% were male. During a mean follow-up of 75.94 ± 17.24 months, 13 patients died, three of them due to cardiac causes, and 13 patients suffered nonfatal AMI. Myocardial ischemia remained an independent predictor of MACE (HR 2.49; [CI] 95% 1.74-3.58). The independent predictors for all-cause mortality were male gender (HR 9.83; [CI] 95% 2.15-44.97) and age over 60 years (HR 4.57; [CI] 95% 1.39-15.23).
  
  
  CONCLUSIONS
  Positive SE for myocardial ischemia is a predictor of MACE in the studied sample, which helps to identify a subgroup of patients at higher risk of events despite having normal ET.
authors.affiliation: Universidade Federal de Sergipe, Aracaju, SE, Brazil.
authors.forename: Flávia Ricci
authors.initials: FR
authors.lastname: Calasans
authors.forename: Bruno Fernandes de Oliveira
authors.initials: BF
authors.lastname: Santos
authors.forename: Débora Consuelo Rocha
authors.initials: DC
authors.lastname: Silveira
authors.forename: Ana Carla Pereira de
authors.initials: AC
authors.lastname: Araújo
authors.forename: Luiza Dantas
authors.initials: LD
authors.lastname: Melo
authors.forename: José Augusto
authors.initials: JA
authors.lastname: Barreto-Filho
authors.forename: Antônio Carlos Sobral
authors.initials: AC
authors.lastname: Sousa
authors.forename: Joselina Luzia Menezes
authors.initials: JL
authors.lastname: Oliveira
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000401:mortality; D025401:Echocardiography, Stress / Q000379:methods*; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D012016:Reference Values; D018570:Risk Assessment; D012307:Risk Factors