Prediction of Mortality by Exercise Echocardiography

Marwick, Thomas H.; Case, Colin; Vasey, Charles; Allen, Susan; Short, Leanne; Thomas, James D.

doi:10.1161/01.cir.103.21.2566

Cited by 186 publications

(47 citation statements)

References 30 publications

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“…22 Multivariate analysis of our data showed ischemia or the finding of an abnormal stress echocardiogram to be an independent predictor of mortality in hypertensive patients, and all of these data are consistent with previous reports in unselected patients with both exercise 5 and dobutamine echocardiography. 6…”

Section: Marwick Et Al Prediction Of Cardiac Death In Hypertensionsupporting

confidence: 91%

“…19,20 Recent studies with exercise and dobutamine echocardiography have shown the yearly event rate with a negative test to be of the order of 1% per year. 5,6 The results of this study of hypertensive patients are consistent with the data obtained in nonhypertensive patients. Previous studies have shown that patients who have events despite a negative test tend to be older, have a history of heart failure, exercise to low workload, or have anginal symptoms or left ventricular hypertrophy.…”

Section: Assessment Of Prognosissupporting

confidence: 89%

“…4 In unselected patients without a history of hypertension, the risk of death from coronary disease may be stratified by features in the clinical history, resting ventricular function, exercise capacity, and the presence and extent of ischemia at stress echocardiography. 5,6 Despite the high prevalence of hypertension among patients presenting with chest pain, there are few available data regarding the validity of this approach in the hypertensive population. However, given the effects of hypertensive heart disease on resting and stress ST-segment changes in the absence of epicardial coronary disease, as well as reduced exercise capacity, there are grounds for suspecting that standard approaches may be ineffective.…”

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confidence: 99%

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Prediction of Outcomes in Hypertensive Patients With Suspected Coronary Disease

et al. 2002

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Abstract-Stress echocardiography has been shown to improve the diagnosis of coronary artery disease in the presence of hypertension, but its value in prognostic evaluation is unclear. We sought to determine whether stress echocardiography could be used to predict mortality in 2363 patients with hypertension, who were followed for up to 10 years (mean 4.0Ϯ1.8) for death and revascularization. Stress echocardiograms were normal in 1483 patients (63%), 16% had resting left ventricular (LV) dysfunction alone, and 21% had ischemia. Abnormalities were confined to one territory in 489 patients (21%) and to multiple territories in 365 patients (15%). Cardiac death was less frequent among the patients able to exercise than among those undergoing dobutamine echocardiography (4% versus 7%, PϽ0.001). The risk of death in patients with a negative stress echocardiogram was Ͻ1% per year. Ischemia identified by stress echocardiography was an independent predictor of mortality in those able to exercise (hazard ratio 2.21, 95% confidence intervals 1.10 to 4.43, Pϭ0.0001) as well as those undergoing dobutamine echo (hazard ratio 2.39, 95% confidence intervals 1.53 to 3.75, Pϭ0.0001); other predictors were age, heart failure, resting LV dysfunction, and the Duke treadmill score. In stepwise models replicating the sequence of clinical evaluation, the results of stress echocardiography added prognostic power to models based on clinical and stress-testing variables. Thus, the results of stress echocardiography are an independent predictor of cardiac death in hypertensive patients with known or suspected coronary artery disease, incremental to clinical risks and exercise results.

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Section: Marwick Et Al Prediction Of Cardiac Death In Hypertensionsupporting

confidence: 91%

Section: Assessment Of Prognosissupporting

confidence: 89%

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confidence: 99%

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Prediction of Outcomes in Hypertensive Patients With Suspected Coronary Disease

et al. 2002

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“…15 Although poor exercise capacity is recognized as an adverse prognostic element, studies which have examined the sensitivity of ETT for the diagnosis of CAD have used the criterion of 85% MPHR as an "adequate" test even if the patient has not exercised beyond 5 METS. 3,4,9 These patients, in general, are deconditioned and achieve their target heart rate in a short period of time. Thus, although their estimated workload (by rate-pressure product) may be adequate, their extent and exposure time to an ischemic supply-demand condition is limited, potentially resulting in a lower sensitivity for an ischemic electrical response in this cohort.…”

Section: Prognostic Value Of the Exercise Treadmill Testingmentioning

confidence: 99%

“…5 -8 Previous studies comparing ESE to ETT have included patients achieving a low workload despite adequate heart rate response, potentially biasing the results against ETT. 3,4,9 Therefore, we hypothesized that given stringent standards of exercise duration and ECG interpretability, the ETT would have a high diagnostic sensitivity for the presence of CAD. Support of this hypothesis would potentially limit the necessity and cost of adjunct echocardiographic imaging in many patients.…”

Section: Introductionmentioning

confidence: 99%

In Search of the False‐negative Exercise Treadmill Testing Evidence‐based Use of Exercise Echocardiography

Southard

Baker

Schaefer

2008

Clinical Cardiology

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SummaryBackground: Controversy exists regarding the role of exercise treadmill testing (ETT) versus exercise stress echocardiography (ESE) as the appropriate initial noninvasive test to risk-stratify patients with chest pain. The majority of studies to date that evaluated these methodologies included patients with poor functional status and baseline electrocardiogram (ECG) abnormalities, potentially limiting the sensitivity of ETT.Hypothesis: We examined the hypothesis that given stringent standards of exercise duration and ECG interpretability, the ETT would have a high diagnostic sensitivity for the presence of significant coronary artery disease (CAD).Methods: Results of concurrent ETT and ESE in 3,098 patients were examined, and the subset of patients with a negative ETT and positive ESE (−ETT/+ESE) were reviewed for the presence of CAD as a function of exercise duration (< or ≥ 6 min) and baseline ECG normality.Results: In those patients with a −ETT/+ESE who exercised ≥ 6 min, 54 had a normal baseline ECG, 22 underwent angiography and 6 had CAD (all of whom had either small, grafted or collateralized vessels). Patients with a −ETT/+ESE who were incapable of exercising 6 min were more frequently older and female. Mortality was significantly greater in the < 6 min exercise duration group (31.4 versus 3.1%).

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