The value of negative stress echocardiography in predicting cardiovascular events among adults with no known coronary disease

Abstract

Introduction: Stress echocardiography is a safe and cost-effective method of evaluating the patients with suspected coronary artery disease (CAD). However, the risk factors of an adverse cardiovascular event after a normal exercise (ESE) or dobutamine (DSE) stress echocardiography are not well established. Methods: A cohort of 705 patients without previous history of CAD and a negative ESE/DSE was studied. All studies were performed in a high-volume echocardiologic laboratory and interpreted by two experienced echocardiography-trained cardiologists. Patients with inconclusive studies and those with an evidence of myocardial ischemia were excluded. Demographic, echocardiographic and hemodynamic findings were recorded. Patients were followed for at least 2 years. Independent predictors of major adverse cardiovascular events (MACE) were determined by regression analysis. Results: During a period of 55.7±17.5 months, MACE occurred in 35 (5.0%) of patients. Negative predictive value (NPV) of DSE was 89.2%, which was significantly less than 96.5% for ESE in predicting the occurrence of MACE (P = 0.001). MACE occurred more frequently among older (≥65 years) men with preexisting diabetes, hypertension, and/or hyperlipidemia. During ESE, a higher maximum blood pressure*heart rate product for the achieved level of metabolic equivalent (METS) of tasks was also an independent predictor of MACE. Conclusion: Inability of patients to undergo traditional ESE that led to the choice of using DSE alternative reduces the NPV of the stress echocardiography among patients without previous history of CAD. A modest rise of heart rate and blood pressure in response to increased level of activity serves as favorable prognostic value and improves the NPV of stress echocardiography.

Downstream Imaging Studies Do Not Significantly Improve Outcome in Most Patients with Chest Pain Who Did Not Reach Their Target Heart Rate on a Stress ECHO Study

“…Of the patients who were indicated for revascularization but were not detected in the stress echo test due to a failure to achieve the target heart rate, eight out of nine of these patients had at least one of the following medical conditions: hypertension, diabetes, and/or known ischemic heart disease. This is in accordance with the study by Niloufar Samiei et al [13], who found that in patients with a negative stress test result or from dobutamine echocardiographic studies MACE occurred more frequently among older (≥65 years) men with preexisting diabetes, hypertension, and/or hyperlipidemia. Most of these patients underwent the SE during hospitalization for chest pain.…”

Diastolic Dysfunction and Impaired Cardiac Output Reserve in Dysmetabolic Nonhuman Primate With Proteinuria

“…Under resting condition, MetS NHPs showed mild left ventricular (LV) diastolic dysfunction (E/A: 1+0.06 vs. 1.5+0. 13), but with preserved ejection fraction (EF: 65+2 vs. 71+3%) compared to CTRL. DSE with an intravenous infusion of dobutamine at ascending doses (5, 10, 20, 30 and 40 μg/kg/min, 7 min for each dose) resulted in a dose-dependent increase in cardiac function, however, with a signi cantly diminished magnitude at the highest dose of dobutamine infusion (40 μg/kg/min) in both diastole (E/A: -12+3 vs. -38+5%) and systole (EF: 25+3 vs. 33+5%) as well as ~42% reduced cardiac output reserve (COR: 63+8 vs. 105+18%, p<0.02) in the MetS compared to CTRL NHPs.…”

Diastolic dysfunction and impaired cardiac output reserve in dysmetabolic nonhuman primate with proteinuria

“…Clinical studies are now available re ning the common use of DSE preoperatively in patients with valvar disease, as well as in emergency cardiac situations [9][10][11]. Recently available long-term results from several independent clinical trials, combined with image enhancements, have improved the ability to detect signs of subtle coronary artery disease and determine myocardial viability [12,13].…”