The clinical efficacy and long-term prognostic value of stress echocardiography in octogenarians.
Although stress echocardiography (SE) is invaluable in younger populations, its prognostic value may be attenuated in the elderly due to shorter life expectancy and the frequent presence of severe comorbidities. This study sought to evaluate the clinical effectiveness of SE in octogenarians, particularly its prognostic value over clinical variables, in predicting hard events.



A total of 374 consecutive octogenarians who underwent SE for evaluation of coronary artery disease (CAD) were assessed for feasibility, diagnostic accuracy and safety of the test, and followed up for hard outcomes (all-cause mortality, cardiovascular (CV) deaths and non-fatal myocardial infarction (NFMI)). Cox regression analysis was performed to identify predictors of outcome.



Of the 374 tests, 360 (96.3%) were diagnostic. Of the 50 patients with inducible ischaemia, 33 patients (66%) proceeded to angiography of which 27 (82%) patients had significant CAD. During long-term follow-up of 4.0±2.0 years, there were 127 deaths and 36 NFMIs. The annualised mortality, NFMI and combined mortality /NFMI rates were 8.1%, 1.8% and 9.4% for patients with a normal SE and 12.1%, 5.5% and 14.1% for those with an abnormal SE, respectively. Predictors of NFMI on multivariate analysis were prior CAD (HR 2.89, CI 1.03 to 8.15, p=0.045), peripheral vascular disease (HR 3.33, CI 1.18 to 9.45, p=0.02), and inducible ischaemia (HR 3.97, CI 1.49 to 10.55, p=0.006). In patients without prior history of CAD, inducible ischaemia was the only independent predictor of NFMI (HR 8.72, CI 1.46 to 52.2, p=0.018). The larger the extent of ischaemia, the greater the incidence of NFMI. The independent predictors of CV events (NFMI or CV mortality) were PAD (HR 2.81, CI 1.21 to 6.52, p=0.016) and peak wall motion score index (HR 5.71, CI 1.67 to 19.6, p=0.006). Although inducible ischaemia predicted all-cause mortality on unadjusted analysis, it did not on multivariate analysis.



In octogenarians, SE demonstrated excellent feasibility, safety and diagnostic accuracy. SE parameters were independent predictors of NFMI and CV events, and the presence of inducible ischaemia was associated with a 50% increase in all-cause mortality.
Department of Cardiology, Northwick Park Hospital, Harrow, UK.|Department of Cardiology, Royal Brompton Hospital, London, UK.|Biomedical Research Unit, National Heart and Lung Institute, Imperial College, London, UK.
Sothinathan
S
Gurunathan
Department of Cardiology, Northwick Park Hospital, Harrow, UK.
Asrar
A
Ahmed
Department of Cardiology, Northwick Park Hospital, Harrow, UK.
Jatinder
J
Pabla
Department of Cardiology, Northwick Park Hospital, Harrow, UK.
Nikos
N
Karogiannis
Department of Cardiology, Northwick Park Hospital, Harrow, UK.
Alina
A
Hua
Department of Cardiology, Northwick Park Hospital, Harrow, UK.
Grace
G
Young
Department of Cardiology, Northwick Park Hospital, Harrow, UK.|Department of Cardiology, Royal Brompton Hospital, London, UK.|Biomedical Research Unit, National Heart and Lung Institute, Imperial College, London, UK.
Benoy Nalin
BN
Shah
Department of Cardiology, Northwick Park Hospital, Harrow, UK.|Department of Cardiology, Royal Brompton Hospital, London, UK.|Biomedical Research Unit, National Heart and Lung Institute, Imperial College, London, UK.
Roxy
R
Senior
D058665:Adrenergic beta-1 Receptor Agonists / Q000008:administration & dosage*; D000367:Age Factors; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging; D004280:Dobutamine / Q000008:administration & dosage*; D025401:Echocardiography, Stress / Q000379:methods*; D005080:Exercise Test; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000000981:diagnostic imaging; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
D058665:Adrenergic beta-1 Receptor Agonists; D004280:Dobutamine