title: Clinical utility and prognostic value of appropriateness criteria in stress echocardiography for the evaluation of valvular heart disease.
abstract: We examined the prognostic value of stress echocardiography appropriateness criteria for evaluation of valvular heart disease in 100 consecutive patients. Of the studies, 49%, 36%, and 15% were classified as appropriate, uncertain, and inappropriate, respectively. Over a median of 12.6 months, 24 events (12 deaths and 12 heart failure admissions) occurred. The 12-month event-free survival was significantly reduced in patients with appropriate or uncertain studies compared with patients with inappropriate studies (p = 0.04 and p = 0.005, respectively). There was no survival difference between patients with an appropriate or uncertain indication (p = 0.1). The only independent predictors of events were a positive stress echocardiogram (hazard ratio: 15.5, p < 0.0001) and left ventricular ejection fraction (hazard ratio: 0.95, p = 0.02). The appropriateness criteria for evaluation of valvular heart disease provide the ability to differentiate between patients at high- (appropriate group) and low- (inappropriate group) risk of cardiac events. Reclassification of the uncertain group may improve the differential value of these criteria.
authors.affiliation: Department of Cardiology and Echocardiography Laboratory, Royal Brompton and Harefield NHS Trust, London, United Kingdom.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Bhattacharyya
authors.forename: Vasilis
authors.initials: V
authors.lastname: Kamperidis
authors.forename: Benoy Nalin
authors.initials: BN
authors.lastname: Shah
authors.forename: Isabelle
authors.initials: I
authors.lastname: Roussin
authors.forename: Navtej
authors.initials: N
authors.lastname: Chahal
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.forename: Rajdeep
authors.initials: R
authors.lastname: Khattar
authors.forename: Roxy
authors.initials: R
authors.lastname: Senior
mesh_terms: D000368:Aged; D025401:Echocardiography, Stress / Q000379:methods*; D015444:Exercise / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016277:Ventricular Function, Left
keywords: dobutamine; exercise; stress echocardiography; valvular heart disease