title: Prognostic value of a negative peak supine bicycle stress echocardiography with or without concomitant ischaemic stress electrocardiographic changes: a cohort study.
abstract: BACKGROUND
  a negative peak supine bicycle exercise stress echocardiography (ESE) was shown to have a long-term favourable prognostic value. Data on the long-term prognosis of ischaemic electrocardiographic (ISECG) changes in the setting of a negative peak supine bicycle ESE are lacking.
  
  
  METHODS
  we evaluated the prognostic value of negative peak supine bicycle ESE with or without concomitant ISECG changes in a referral population evaluated for chest pain after an inconclusive first-line work-up including clinical evaluation and exercise ECG stress.
  
  
  METHODS
  from 2003 to 2010, patients who underwent a peak supine bicycle ESE and were deemed to be negative were evaluated. Two groups based on concomitant stress ECG tracing were analysed - those with normal stress ECG and those with ISECG changes. The primary endpoint was cumulative incidence of cardiovascular death, hospitalizations for acute coronary syndrome and coronary revascularizations.
  
  
  RESULTS
  a total of 371 patients (mean age 59.1 ± 12.1 years, 49.9% women) were studied. Of those, 141 (38.0%) had concomitant ISECG changes. Mean follow-up was 3.46 ± 1.76 years. The primary endpoint occurred in 3.0% of patients, (2.2% in those with normal stress ECG, and in 4.3% with ISECG changes, p = 0.251); with unadjusted hazard ratio for primary endpoint of 2.04 (95%CI 0.62-6.69, p = 0.239) in patients with ISECG changes compared to those with normal stress ECG.
  
  
  CONCLUSIONS
  in an outpatient population without known CAD evaluated for chest pain after inconclusive first-line work-up, a negative peak supine bicycle ESE confers an excellent prognosis regardless of the nature of concomitant stress ECG abnormalities.
authors.affiliation: Department of Cardiology, Policlinico Hospital, Modena and Reggio Emilia University, Modena, Italy olmoberg@libero.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Barbieri
authors.affiliation: Department of Cardiology, Policlinico Hospital, Modena and Reggio Emilia University, Modena, Italy Cardiovascular Ultrasound Imaging and Hemodynamic Laboratory, Mayo Clinic, Rochester, MN, USA.
authors.forename: Francesca
authors.initials: F
authors.lastname: Mantovani
authors.affiliation: Department of Cardiology, Policlinico Hospital, Modena and Reggio Emilia University, Modena, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Bursi
authors.affiliation: Department of Cardiology, Policlinico Hospital, Modena and Reggio Emilia University, Modena, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Ruggerini
authors.affiliation: Department of Cardiology, Policlinico Hospital, Modena and Reggio Emilia University, Modena, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Lugli
authors.affiliation: Cardiovascular Ultrasound Imaging and Hemodynamic Laboratory, Mayo Clinic, Rochester, MN, USA Division of Cardiovascular Diseases, Assiut University, Egypt.
authors.forename: Sahar S
authors.initials: SS
authors.lastname: Abdelmoneim
authors.affiliation: Modena and Reggio Emilia University, Modena, Italy.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Modena
mesh_terms: D000368:Aged; D002637:Chest Pain / Q000000981:diagnostic imaging* / Q000401:mortality; D025401:Echocardiography, Stress; D004562:Electrocardiography; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016683:Supine Position / Q000502:physiology*
keywords: Stress electrocardiography; exercise stress echocardiography; ischaemia; prognosis