HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bergeron, S. Articles by Pellikka, P. A. Search for Related Content PubMed PubMed Citation Articles by Bergeron, S. Articles by Pellikka, P. A.

CLINICAL RESEARCH: ECHOCARDIOGRAPHY

Exercise echocardiographic findings and outcome of patients referred for evaluation of dyspnea

Sébastien Bergeron, MD^*, Steve R. Ommen, MD^*, Kent R. Bailey, PhD, Jae K. Oh, MD^*, Robert B. McCully, MD^* and Patricia A. Pellikka, MD^*,*

^* Division of Cardiovascular Diseases, Rochester, Minnesota, USA
Department of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA

Manuscript received September 3, 2003; revised manuscript received February 25, 2004, accepted March 23, 2004.

^* Reprint requests and correspondence: Dr. Patricia A. Pellikka, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA.
pellikka.patricia{at}mayo.edu

OBJECTIVES: The purpose of this study was to characterize the outcome of patients referred for exercise echocardiographic evaluation of dyspnea.

BACKGROUND: Little information exists regarding outcome of patients with dyspnea.

METHODS: We identified 443 patients with unexplained dyspnea, 2,033 with chest pain, and 587 with both symptoms referred for exercise echocardiography.

RESULTS: Compared to those with chest pain alone, patients referred for dyspnea alone were older, predominately men, and had lower workload, lower ejection fraction (EF), more prior myocardial infarction (MI), and abnormal rest electrocardiograms. Patients with both symptoms were similar to those with dyspnea, but more had prior revascularization. Exercise echocardiography showed ischemia in 42% of patients with dyspnea, 19% with chest pain, and 58% with both symptoms. During 3.1 ± 1.8 years follow-up, cardiac death (5.2% vs. 0.9%, p < 0.0001) and nonfatal MI (4.7% vs. 2.0%, p < 0.0001) occurred more often in patients with dyspnea. Events in patients with both symptoms were similar to those with dyspnea, except for revascularization (20% vs. 13%, p = 0.0004). For patients with dyspnea, independent predictors of events were previous MI (hazard ratio [HR] 3.35, p < 0.0001), male gender (HR 1.94, p = 0.0252), EF (HR 0.95/10% increment, p < 0.0001), and increase in wall motion score index with exercise (HR 4.19/0.25 U, p < 0.0001), but not chest pain.

CONCLUSIONS: Patients with unexplained dyspnea have a high likelihood of ischemia and an increased incidence of cardiac events. Exercise echocardiography provides independent information for identifying patients at risk. In patients with known or suspected coronary artery disease, dyspnea is a symptom requiring investigation.

Abbreviations and Acronyms   CAD = coronary artery disease   EF = ejection fraction   HR = hazard ratio   MI = myocardial infarction   NYHA = New York Heart Association   WMSI = wall motion score index

This article has been cited by other articles:

				D. Patel, V. J.B. Robinson, R. B. Arteaga, and J. W. Thornton Diastolic Filling Parameters Derived from Myocardial Perfusion Imaging Can Predict Left Ventricular End-Diastolic Pressure at Subsequent Cardiac Catheterization J. Nucl. Med., May 1, 2008; 49(5): 746 - 751. [Abstract] [Full Text] [PDF]

				R. J. Gibbons, T. D. Miller, D. Hodge, L. Urban, P. A. Araoz, P. Pellikka, and R. B. McCully Application of Appropriateness Criteria to Stress Single-Photon Emission Computed Tomography Sestamibi Studies and Stress Echocardiograms in an Academic Medical Center J. Am. Coll. Cardiol., April 1, 2008; 51(13): 1283 - 1289. [Abstract] [Full Text] [PDF]

				J. Peteiro, I. Bendayan, J. Marinas, R. Campos, B. Bouzas, and A. Castro-Beiras Prognostic value of mitral regurgitation assessment during exercise echocardiography in patients with left ventricular dysfunction: A follow-up study of 1.7 {+/-} 1.5 years Eur J Echocardiogr, January 1, 2008; 9(1): 18 - 25. [Abstract] [Full Text] [PDF]

				V. Froelich Dyspnoea at cardiac stress testing was associated with an increased risk of death in symptomatic and asymptomatic people Evid. Based Med., June 1, 2006; 11(3): 91 - 91. [Full Text] [PDF]

				M. I. Burgess, C. Jenkins, J. E. Sharman, and T. H. Marwick Diastolic Stress Echocardiography: Hemodynamic Validation and Clinical Significance of Estimation of Ventricular Filling Pressure With Exercise J. Am. Coll. Cardiol., May 2, 2006; 47(9): 1891 - 1900. [Abstract] [Full Text] [PDF]

				T. H. Marwick Dyspnea and risk in suspected coronary disease. N. Engl. J. Med., November 3, 2005; 353(18): 1963 - 1965. [Full Text] [PDF]

				S. Stern Symptoms Other Than Chest Pain May Be Important in the Diagnosis of "Silent Ischemia," or "The Sounds of Silence" Circulation, June 21, 2005; 111(24): e435 - e437. [Full Text] [PDF]

				A. E. Weyman The year in echocardiography J. Am. Coll. Cardiol., February 1, 2005; 45(3): 448 - 455. [Full Text] [PDF]

				A. N. DeMaria, O. Ben-Yehuda, D. Berman, G. K. Feld, B. H. Greenberg, J. D. Knoke, K. U. Knowlton, W. Y.W. Lew, J. Narula, D. Sahn, et al. Highlights of the year in JACC 2004 J. Am. Coll. Cardiol., January 4, 2005; 45(1): 137 - 153. [Full Text] [PDF]