title: Prognostic Value of Stress Echocardiography in Patients With Low-Intermediate or High Short-Term (10 Years) Versus Low (<39%) or High (≥39%) Lifetime Predicted Risk of Cardiovascular Disease According to the American College of Cardiology/American Heart Association 2013 Cardiovascular Risk Calculator.
abstract: This study evaluates the prognostic value of stress echocardiography (Secho) in short-term (10 years) and lifetime atherosclerotic cardiovascular disease risk-defined groups according to the American College of Cardiology/American Heart Association 2013 cardiovascular risk calculator. The ideal risk assessment and management of patients with low-to-intermediate or high short-term versus low (<39%) or high (≥39%) lifetime CV risk is unclear. The purpose of this study was to evaluate the prognostic value of Secho in short-term and lifetime CV risk-defined groups. We evaluated 4,566 patients (60 ± 13 years; 46% men) who underwent Secho (41% treadmill and 59% dobutamine) with low-intermediate short-term (<20%) risk divided into low (<39%, n = 368) or high (≥39%, n = 661) lifetime CV risk and third group with high short-term risk (≥20%, n = 3,537). Follow-up (3.2 ± 1.5 years) for nonfatal myocardial infarction (n = 102) and cardiac death (n = 140) were obtained. By univariate analysis, age (p <0.001) and ≥3 new ischemic wall motion abnormalities (WMAs, p <0.001) were significant predictors of cardiac events. Cumulative survival in patients was significantly worse in patients with ≥3 WMA versus <3 WMA in low-intermediate short-term and low (3.3% vs 0.3% per year, p <0.001) or high (2.0% vs 0% per year, p <0.001) lifetime risk and also in those with high short-term CV risk group (3.5% vs 1.0% per year, p <0.001). Multivariate Cox proportional hazards analysis identified ≥3 new ischemic WMAs as the strongest predictor of cardiac events (hazard ratio 3.0, 95% confidence interval 2.3 to 3.9, p <0.001). In conclusion, Secho results (absence or presence of ≥3 new ischemic segments) can further refine risk assessment in patients with low-intermediate or high short-term versus low or high lifetime cardiovascular risk. Event rate with normal Secho is low (≤1% per year) but higher in patients with high short-term CV risk by the American College of Cardiology/American Heart Association 2013 cardiovascular risk calculator.
authors.affiliation: Division of Cardiology, Department of Medicine, Valley Health System, Ridgewood, New Jersey.
authors.forename: Siu-Sun
authors.initials: SS
authors.lastname: Yao
authors.affiliation: Division of Cardiology, Department of Medicine, Mount Sinai Health System, New York, New York.
authors.forename: Azhar
authors.initials: A
authors.lastname: Supariwala
authors.affiliation: Valley Health System, Ridgewood, New Jersey.
authors.forename: Amanda
authors.initials: A
authors.lastname: Yao
authors.affiliation: Division of Cardiology, Department of Medicine, Mount Sinai Health System, New York, New York.
authors.forename: Sai Sreenija
authors.initials: SS
authors.lastname: Dukkipati
authors.affiliation: Richmond University Medical Center, Staten Island, New York.
authors.forename: Jamshad
authors.initials: J
authors.lastname: Wyne
authors.affiliation: Division of Cardiology, Department of Medicine, Mount Sinai Health System, New York, New York. Electronic address: farooq.chaudhry@mountsinai.org.
authors.forename: Farooq A
authors.initials: FA
authors.lastname: Chaudhry
mesh_terms: D000572:American Heart Association; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D004280:Dobutamine / Q000008:administration & dosage; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009518:New York / Q000453:epidemiology; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013997:Time Factors; D014481:United States; D016277:Ventricular Function, Left / Q000502:physiology
chemical_list: D004280:Dobutamine