title: The prognostic role of stress echocardiography in a contemporary population and the clinical significance of limited apical ischaemia.
abstract: BACKGROUND
  In this study, we aim to reassess the prognostic value of stress echocardiography (SE) in a contemporary population and to evaluate the clinical significance of limited apical ischaemia, which has not been previously studied.
  
  
  METHODS
  We included 880 patients who underwent SE. Follow-up data with regards to MACCE (cardiac death, myocardial infarction, any repeat revascularisation and cerebrovascular accident) were collected over 12 months after the SE. Mortality data were recorded over 27.02 ± 4.6 months (5.5-34.2 months). We sought to investigate the predictors of MACCE and all-cause mortality.
  
  
  RESULTS
  In a multivariable analysis, only the positive result of SE was predictive of MACCE (HR, 3.71; P = 0.012). The positive SE group was divided into 2 subgroups: (a) inducible ischaemia limited to the apical segments ('apical ischaemia') and (b) ischaemia in any other segments with or without apical involvement ('other positive'). The subgroup of patients with apical ischaemia had a significantly worse outcome compared to the patients with a negative SE (HR, 3.68; P = 0.041) but a similar outcome to the 'other positive' subgroup. However, when investigated with invasive coronary angiography, the prevalence of coronary artery disease (CAD) and their rate of revascularisation was considerably lower. Only age (HR, 1.07; P < 0.001) was correlated with all-cause mortality.
  
  
  CONCLUSIONS
  SE remains a strong predictor of patients' outcome in a contemporary population. A positive SE result was the only predictor of 12-month MACCE. The subgroup of patients with limited apical ischaemia have similar outcome to patients with ischaemia in other segments despite a lower prevalence of CAD and a lower revascularisation rate.
authors.affiliation: Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom alexandros.papachristidis@nhs.net.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Papachristidis
authors.affiliation: Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Damian
authors.initials: D
authors.lastname: Roper
authors.affiliation: Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Daniela
authors.initials: D
authors.lastname: Cassar Demarco
authors.affiliation: Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Tsironis
authors.affiliation: Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Papitsas
authors.affiliation: Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Byrne
authors.affiliation: Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom.|Lewisham Healthcare NHS Trust, London, United Kingdom.
authors.forename: Khaled
authors.initials: K
authors.lastname: Alfakih
authors.affiliation: Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Monaghan
keywords: MACCE; apical ischaemia; outcome; stress echocardiography