Stress echo results predict mortality: a large-scale multicenter prospective international study
Rosa Sicari, MD, PhD*,*,
Emilio Pasanisi, MD*,
Lucia Venneri, MD*,
Patrizia Landi, BSc*,
Lauro Cortigiani, MD*,
Eugenio Picano, MD, PhD* Echo Persantine International Cooperative (EPIC) and Echo Dobutamine International Cooperative (EDIC) Study Groups
* National Council of Research, Institute of Clinical Physiology, Pisa, Italy
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Figure 1 Kaplan-Meier survival curves (considering cardiac death as an end point) in patients with presence (DET +) and absence (DET –) of myocardial ischemia at pharmacologic stress echocardiography. Survival is worse in patients with inducible ischemia.
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Figure 2 Kaplan-Meier survival curves (considering total mortality as an end point) in patients with presence (DET +) and absence (DET –) of myocardial ischemia pharmacologic stress echocardiography. Survival is worse in patients with inducible ischemia.
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Figure 3 Kaplan-Meier survival curves (considering death as an end point) in patients with a positive pharmacologic stress echo test separated on the basis of the extent of the inducible ischemia identified by the delta wall motion score index (WMSI) set at 0.37. The survival is worse for larger variations of WMSI; Delta WMSI >0.37 versus Delta WMSI <0.37.
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Figure 4 Kaplan-Meier survival curves (considering cardiac death) in patients stratified according to DET test results in relation to the pharmacologic dose achieved. Low-dose positivity was considered to have occurred during the dose of 0.56 mg/kg in 4 min of dipyridamole or during the following 4 min or at the dose  20 µg/kg/min of dobutamine (high-dose positivity vs. low-dose positivity, p = 0.0000).
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Figure 5 Bar graph showing global chi-square value of significant predictor modeling of cardiac mortality according to an interactive procedure. In the model, stress echocardiographic parameters still added significant information to clinical variables and rest echocardiographic parameters. WMSI = wall motion score index.
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Figure 6 Bar graph showing global chi-square value of significant predictor modeling of total mortality according to an interactive procedure. In the model, stress echocardiographic parameters still added significant information to clinical variables and rest echocardiographic parameters. WMSI = wall motion score index.
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Figure 7 Bar graph showing incremental value of pharmacologic stress echocardiography results to clinical characteristics and coronary angiography for prediction of cardiac outcome in 4,037 patients who underwent pharmacologic stress echocardiography and coronary angiography. WMSI = wall motion score index.
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