Practical applications in stress echocardiography: risk stratification and prognosis in patients with known or suspected ischemic heart disease

J Am Coll Cardiol. 2003 Sep 17;42(6):1084-90. doi: 10.1016/s0735-1097(03)00923-9.

Abstract

Objectives: The purpose of this study was to define appropriate parameters for risk stratification and prognosis in patients undergoing stress echocardiography.

Background: Stress echocardiography is an established technique for the diagnosis of coronary artery disease. However, current data on risk stratification of patients undergoing stress echocardiography are limited.

Methods: We evaluated 1,500 patients (59 +/- 13 years old; 51% male) undergoing stress echocardiography (34% with treadmill exercise and 66% with dobutamine). Resting left ventricular ejection fraction (EF) and regional wall motion were assessed by the consensus of two echocardiographers. Follow-up (mean 2.7 +/- 1.0 years) for confirmed non-fatal myocardial infarction (n = 31) and cardiac death (n = 44) were performed.

Results: By univariate analysis, both the peak wall motion score index (WMSI) (p < 0.0001) and EF (p < 0.0001) were significant predictors of cardiac events. Peak WMSI effectively risk stratified patients into low (0.9%/year), intermediate (3.1%/year), and high (5.2%/year) risk groups (p < 0.0001). A threshold of 45% EF provided further risk stratification of all WMSI groups. By multivariate logistic regression analysis, peak WMSI (relative risk [RR] 2.1, 95% confidence interval [CI] 1.0 to 4.4; p = 0.04) and EF (RR 1.0, 95% CI 0.9 to 1.0; p = 0.01) were both predictors of cardiac events.

Conclusions: Stress echocardiography yields prognostic information for risk stratification of patients with known or suspected ischemic heart disease. A normal stress echocardiographic study (peak WMSI = 1.0) confers a benign prognosis (0.9%/year cardiac event rate). Peak WMSI >1.7 and EF < or =45% are independent markers of patients at high risk of an adverse clinical outcome.

MeSH terms

  • Echocardiography, Stress*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Myocardial Ischemia / diagnostic imaging*
  • Myocardial Ischemia / physiopathology*
  • Prognosis
  • Risk Assessment
  • Stroke Volume