title: Temporal changes in the use and results of exercise echocardiography.
abstract: OBJECTIVE
  Limited data are available regarding changes over time in referral patterns and outcomes of non-invasive cardiac stress testing. Our aim was to evaluate the temporal changes in the use and results of exercise echocardiography in our area of reference.
  
  
  RESULTS
  A total of 12 339 patients referred to our unit for exercise echocardiography between 1997 and 2012 were included. We divided the 16-year period into four quadrennia and evaluated the changes in clinical data, results of the tests, referrals for invasive management and outcomes. We observed a gradual decrease in the frequency of detection of myocardial ischaemia from 35.3% in1997-2000 to 25.4% in 2009-12 (P < 0.001). There was also a progressive increase in the prevalence of cardiovascular risk factors and in the frequency of non-ischaemic chest pain and dyspnoea, while the proportion of patients with prior myocardial infarction and non-interpretable electrocardiograms declined. The rate of referral to coronary angiography within 6 months decreased from 24.8% in 1997-2000 to 19.6% in 2009-12 (P < 0.001), but the rate of coronary revascularization remained almost unchanged (13.1 to 11.7%, P for the trend = 0.16). We also observed a progressive decrease in the 1-year mortality rate from 3.4 to 1% (P < 0.001).
  
  
  CONCLUSIONS
  Over a 16-year period, there was a gradual decrease in the frequency of myocardial ischaemia among patients referred to our unit for exercise echocardiography, which was parallel to changes in their clinical profile. However, this was not accompanied by a significant reduction in the rate of coronary revascularization.
authors: Unidad de Imagen y Función Cardíacas, Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), As Xubias, 84, A Coruña 15006, Spain alberto.bouzas.mosquera@sergas.es.
authors: Alberto
authors: A
authors: Bouzas-Mosquera
authors: Unidad de Imagen y Función Cardíacas, Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), As Xubias, 84, A Coruña 15006, Spain.
authors: Jesús
authors: J
authors: Peteiro
authors: Departamento de Tecnologías de la Información, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
authors: Francisco J
authors: FJ
authors: Broullón
authors: Unidad de Hemodinámica, Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
authors: Ramón
authors: R
authors: Calviño-Santos
authors: Servicio de Cirugía Cardiaca, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
authors: Víctor X
authors: VX
authors: Mosquera
authors: Unidad de Imagen y Función Cardíacas, Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), As Xubias, 84, A Coruña 15006, Spain.
authors: Gabriel
authors: G
authors: Sánchez-Fernández
authors: Unidad de Imagen y Función Cardíacas, Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), As Xubias, 84, A Coruña 15006, Spain.
authors: Cayetana
authors: C
authors: Barbeito-Caamaño
authors: Unidad de Imagen y Función Cardíacas, Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), As Xubias, 84, A Coruña 15006, Spain.
authors: Lucía
authors: L
authors: Pérez-Cebey
authors: Unidad de Imagen y Función Cardíacas, Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), As Xubias, 84, A Coruña 15006, Spain.
authors: Dolores
authors: D
authors: Martínez
authors: Unidad de Imagen y Función Cardíacas, Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), As Xubias, 84, A Coruña 15006, Spain.
authors: Juan C
authors: JC
authors: Yáñez
authors: Unidad de Imagen y Función Cardíacas, Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), As Xubias, 84, A Coruña 15006, Spain.
authors: Nemesio
authors: N
authors: Álvarez-García
authors: Unidad de Hemodinámica, Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
authors: José Manuel
authors: JM
authors: Vázquez-Rodríguez
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000401:mortality; D015897:Comorbidity; D025401:Echocardiography, Stress; D004562:Electrocardiography; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors
keywords: coronary angiography; echocardiography; exercise; myocardial ischaemia; revascularization