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CLINICAL RESEARCH: STRESS ECHOCARDIOGRAPHY

Practical applications in stress echocardiography

Risk stratification and prognosis in patientswith known or suspected ischemic heart disease

^* Department of Medicine, Division of Cardiology, St. Luke's–Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York, USA

Manuscript received August 9, 2002; revised manuscript received May 16, 2003, accepted May 21, 2003.

^* Reprint requests and correspondence: Dr. Farooq A. Chaudhry, St. Luke's–Roosevelt Hospital Center, Division of Cardiology, 1111 Amsterdam Avenue, New York, New York 10025, USA.
fchaudhr{at}chpnet.org

This work was presented in part at the 51st Annual Scientific Sessions of the American College of Cardiology, Atlanta, Georgia, March 17–20, 2002.

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 45% are independent markers of patients at high risk of an adverse clinical outcome.

Abbreviations and Acronyms   CAD   coronary artery disease   EF   ejection fraction   LV   left ventricle/ventricular   MI   myocardial infarction   WMSI   wall motion score index

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