Outcome by Exercise Echocardiography in Patients with Low Pretest Probability of Coronary Artery Disease.
Recommendations for testing in patients with low pretest probability of coronary artery disease differ in guidelines from no testing at all to different tests. The aim of this study was to assess the value of exercise echocardiography (ExE) to define outcome in this population.



A retrospective analysis was conducted of 1,436 patients with low pretest probability of coronary artery disease (<15%) who underwent initial ExE. Overall mortality, major adverse cardiac events (MACEs), defined as cardiac death or nonfatal myocardial infarction, and revascularization during follow-up, were assessed. Ischemia (development of new wall motion abnormalities with exercise) and fixed wall motion abnormalities were measured.



The mean age was 50 ± 12 years. Resting wall motion abnormalities were seen in 13 patients (0.9%) and ischemia in 108 (7.5%). During follow-up, 38 patients died, 10 of cardiac death (annualized death rate, 0.39%); 20 patients had MACEs (annualized MACE rate, 0.21%); and 48 patients (29 with ischemia) underwent revascularization (annualized revascularization rate, 0.51%). The number and percentage of MACEs in the abnormal and normal ExE groups were similar (two [1.7%] vs 18 [1.4%], P = .70), as was the annualized MACE rate (0.31% vs 0.21%, P = .50). Peak left ventricular ejection fraction exhibited a nonsignificant trend for predicting MACEs (P = .11). The number of studies needed to detect an abnormal finding was 12.6 and to detect a patient with extensive ischemia was 26.1.



ExE offers limited prognostic information in patients with low pretest probability of coronary artery disease. The small number of abnormal findings on ExE and low event rates and the large number of studies needed to detect an abnormal finding limit further the value of imaging in this population.
Department of Cardiology, Complejo Hospitalario Universitario de A Coruña, Instituto de Investigacion Biomedica de A Coruña and Universidad de A Coruña, A Coruña, Spain. Electronic address: pete@canalejo.org.
Jesus
J
Peteiro
Department of Cardiology, Complejo Hospitalario Universitario de A Coruña, Instituto de Investigacion Biomedica de A Coruña and Universidad de A Coruña, A Coruña, Spain.
Alberto
A
Bouzas-Mosquera
Department of Information Technology, Complejo Hospitalario Universitario de A Coruña, Instituto de Investigacion Biomedica de A Coruña and Universidad de A Coruña, A Coruña, Spain.
Javier
J
Broullon
Department of Cardiology, Complejo Hospitalario Universitario de A Coruña, Instituto de Investigacion Biomedica de A Coruña and Universidad de A Coruña, A Coruña, Spain.
Gabriel
G
Sanchez-Fernandez
Department of Cardiology, Complejo Hospitalario Universitario de A Coruña, Instituto de Investigacion Biomedica de A Coruña and Universidad de A Coruña, A Coruña, Spain.
Lucia
L
Perez-Cebey
Department of Cardiology, Complejo Hospitalario Universitario de A Coruña, Instituto de Investigacion Biomedica de A Coruña and Universidad de A Coruña, A Coruña, Spain.
Juan
J
Yañez
Department of Cardiology, Complejo Hospitalario Universitario de A Coruña, Instituto de Investigacion Biomedica de A Coruña and Universidad de A Coruña, A Coruña, Spain.
Dolores
D
Martinez
Department of Cardiology, Complejo Hospitalario Universitario de A Coruña, Instituto de Investigacion Biomedica de A Coruña and Universidad de A Coruña, A Coruña, Spain.
Jose M
JM
Vazquez-Rodriguez
D015897:Comorbidity; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000601:surgery; D017063:Outcome Assessment, Health Care / Q000379:methods; D062645:Percutaneous Coronary Intervention / Q000401:mortality / Q000706:statistics & numerical data; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate; D016896:Treatment Outcome
Coronary artery disease; Exercise echocardiography; Low pretest probability