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J Am Coll Cardiol, 2001; 37:1036-1041
© 2001 by the American College of Cardiology Foundation
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CLINICAL STUDY: STRESS TESTING

Prognostic value of exercise echocardiography in 2,632 patients ≥65 years of age

Adelaide M. Arruda, MD, MSa, Mini K. Das, MDa, Veronique L. Roger, MD, MPH, FACCa, Kyle W. Klarich, MD, FACCa, Douglas W. Mahoney, MSa and Patricia A. Pellikka, MD, FACCa

a Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA

Manuscript received June 5, 2000; revised manuscript received November 3, 2000, accepted December 1, 2000.

Reprint requests and correspondence: Dr. Patricia A. Pellikka, Mayo Clinic, Division of Cardiovascular Diseases and Internal Medicine, 200 First Street SW, Rochester, Minnesota 55905
pellikka.patricia{at}mayo.edu

OBJECTIVES

We sought to determine the prognostic value of exercise echocardiography in the elderly.

BACKGROUND

Limited data exist regarding the prognostic value of exercise testing in the elderly, a population which may be less able to exercise and is at increased risk of cardiac death.

METHODS

Follow-up (2.9 ± 1.7 years) was obtained in 2,632 patients ≥65 years who underwent exercise echocardiography.

RESULTS

There were 1,488 (56%) men and 1,144 (44%) women (age 72 ± 5 years). The rest ejection fraction was 56 ± 9%. Rest wall motion abnormalities were present in 935 patients (36%). The mean work load was 7.7 ± 2.3 metabolic equivalents (METs) for men and 6.5 ± 1.9 METs for women. New or worsening wall motion abnormalities developed with stress in 1,082 patients (41%). Cardiac events included cardiac death in 68 patients and nonfatal myocardial infarction in 80 patients. The addition of the exercise electrocardiogram to the clinical and rest echocardiographic model provided incremental information in predicting both cardiac events (chi-square = 77 to chi-square = 86, p = 0.003) and cardiac death (chi-square = 71 to chi-square = 86, p < 0.0001). The addition of exercise echocardiographic variables, especially the change in left ventricular end-systolic volume with exercise and the exercise ejection fraction, further improved the model in terms of predicting cardiac events (chi-square = 86 to chi-square = 108, p < 0.0001) and cardiac death (chi-square = 86 to chi-square = 99, p = 0.004).

CONCLUSIONS

Exercise echocardiography provides incremental prognostic information in patients ≥65 years of age. The best model included clinical, exercise testing and exercise echocardiographic variables.

Abbreviations and Acronyms
  CI = confidence interval
  ECG = electrocardiogram
  EF = ejection fraction
  LA = limits of agreement
  LVESV = left ventricular end-systolic volume
  METs = metabolic equivalents
  MI = myocardial infarction
  RR = risk ratio
  WMSI = wall motion score index




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