European Heart Journal Advance Access published online on October 12, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp427
Prognostic value of peak and post-exercise treadmill exercise echocardiography in patients with known or suspected coronary artery disease
1 Department of Cardiology, Complejo Hospitalario Universitario de A Coruña, As Xubias, 84, A Coruña 15006, Spain
2 Department of Information Technology, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
Received 2 March 2009; revised 17 June 2009; accepted 20 August 2009 * Corresponding author. Tel: +34 981 917 859, Fax: +34 981 178 258, Email: pete{at}canalejo.org
Aims: Although peak may have higher sensitivity than post-treadmill exercise echocardiography (EE) for the detection of coronary artery disease (CAD), its prognostic value remains unknown. We sought to assess the relative values of peak and post-EE for predicting outcome in patients with known/suspected CAD.
Methods and results: We studied 2947 patients who underwent EE. Wall motion score index (WMSI) was evaluated at rest, peak, and post-exercise. Ischaemia was defined as the development of new or worsening wall motion abnormalities with exercise. Separate analyses for all-cause mortality and major cardiac events (MACE) were performed. Ischaemia developed in 544 patients (18.5%). Among them, ischaemia was detected only at peak exercise in 124 patients (23%), whereas 414 (76%) had ischaemia at peak plus post-exercise imaging and six patients (1%) had ischaemia only at post-exercise. During follow-up, 164 patients died. The 5-year mortality rate was 3.5% in patients without ischaemia, 15.3% in patients with peak ischaemia alone, and 14% in patients with post-exercise ischaemia (P < 0.001 normal vs. ischaemic groups). In the multivariate analysis, post-exercise WMSI was an independent predictor of MACE [hazard ratio (HR) 1.87, 95% confidence interval (CI) 1.09–2.19, P = 0.02]. Peak exercise WMSI was an independent predictor of MACE (HR 2.19, 95% CI 1.30–3.69, P = 0.003) and mortality (HR 1.58, 95% CI 1.07–2.35, P = 0.02). The addition of peak EE results to clinical, resting echocardiography, exercise variables, and post-EE provided incremental prognostic information for MACE (P = 0.04) and mortality (P = 0.04).
Conclusion: Peak treadmill EE provides significant incremental information over post-EE for predicting outcome in patients with known or suspected CAD.
Key Words: Exercise testing • Exercise echocardiography • Prognosis