title: Long-term prognostic value of peak exercise echocardiogram in patients hospitalized with acute chest pain.
abstract: BACKGROUND
  Peak exercise echocardiogram (EEcho) has shown reasonable sensitivity and specificity in detecting significant coronary artery disease (CAD). The objective was to evaluate the prognostic value of EEcho in patients hospitalized for acute chest pain (CP) and its additional prognostic information regarding exercise electrocardiogram test (EECG).
  
  
  METHODS
  Prospective observational study performed between May 2011 and September 2013, including 250 patients consecutively admitted for acute CP with normal cardiac biomarkers and nondiagnostic electrocardiogram. All patients were prospectively followed for 1 year, and major adverse cardiovascular events (MACE) were recorded: cardiac death, nonfatal myocardial infarction (MI), or angina with coronary revascularization.
  
  
  RESULTS
  EEcho was positive in 16%. Patients with positive EEcho had a higher incidence of hypertension and higher TIMI risk score, showing significant CAD in 66%. We observed contradictory results (EECG-EEcho) in 20%. Patients with positive EEcho and negative EECG had significant CAD in the 66%, and patients undergoing coronary angiography with negative EEcho and positive EECG did not show significant coronary artery disease. Only positive EEcho (P<.001, HR 0.169; 95% CI, 0.088-0.250) and atrial fibrillation (P<.025, HR 0.125; 95% CI, 0.016-0.233) were independently associated with MACE during follow-up. In patients with negative EEcho, the presence of MACE was 2%.
  
  
  CONCLUSIONS
  EEcho in patients hospitalized for acute chest pain presents good ability to diagnose acute coronary syndrome, while providing additional information when combined with an EECG in up to 20% of cases. Moreover, a negative EEcho in this cohort seems to provide prognostic information beyond the acute event to predict long-term MACE.
authors.affiliation: Torrecardenas Hospital, Almeria, Spain.
authors.forename: German
authors.identifier: http://orcid.org/0000-0003-0033-007X
authors.initials: G
authors.lastname: Merchan Ortega
authors.affiliation: Torrecardenas Hospital, Almeria, Spain.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Bonaque Gonzalez
authors.affiliation: Torrecardenas Hospital, Almeria, Spain.
authors.forename: Alejandro Dionisio
authors.initials: AD
authors.lastname: Sanchez Espino
authors.affiliation: Torrecardenas Hospital, Almeria, Spain.
authors.forename: Maria Jose
authors.initials: MJ
authors.lastname: Aguado Martin
authors.affiliation: Torrecardenas Hospital, Almeria, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Navarro Garcia
authors.affiliation: Torrecardenas Hospital, Almeria, Spain.
authors.forename: Fuensanta
authors.initials: F
authors.lastname: Ruiz Lopez
authors.affiliation: Torrecardenas Hospital, Almeria, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Ramos Perales
authors.affiliation: Ramon y Cajal University Hospital, Madrid, Spain.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Zamorano Gomez
mesh_terms: D000208:Acute Disease; D000368:Aged; D002637:Chest Pain / Q000209:etiology* / Q000503:physiopathology; D004452:Echocardiography / Q000379:methods*; D004562:Electrocardiography / Q000379:methods; D005080:Exercise Test / Q000706:statistics & numerical data*; D005260:Female; D006331:Heart Diseases / Q000150:complications* / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity
keywords: chest pain; coronary artery disease; exercise echocardiogram