Abstract 16183: Predictors of Myocardial Injury in Patients With Negative Stress Echocardiogram

Abstract

Background: A negative result on stress echocardiography (SE) is generally associated with a low risk of cardiovascular events and carries a favorable prognosis. The present study was conducted to identify clinical and echocardiographic characteristics associated with increased risk of myocardial injury following a negative SE (NSE). Methods: We retrospectively identified a total of 4130 SEs performed between 2013 and 2017 at a tertiary care center. NSE was defined as the absence of a new or worsening wall motion abnormality (WMA) with stress. Patients with resting WMA on SE were excluded. The occurrence of myocardial injury following index SE within 1 year was then recorded. Myocardial injury was defined as an elevated (>99 th percentile of the upper reference limit of normal) and changing troponin value (a rise and/or fall of the troponin value observed) following index SE. Results: During the study period, 2962 patients with NSE met inclusion criteria (median age 58 years-old; 50% females). Baseline characteristics were as follows: 35% diabetic, 49% hyperlipidemic, 62% hypertensive, 41% had a history of smoking, 21% had a history of coronary artery disease (CAD), 24% had end-stage liver disease (ESLD), 5% had end-stage renal disease (ESRD) and 1.5% had a left ventricular ejection fraction (LVEF) < 50%. Around 5% of patients developed myocardial injury within 1 year of NSE. Age, diabetes mellitus, ESLD and a LVEF <50% were significantly associated with an increased risk of myocardial injury on univariate and multivariate analysis (p<0.013) (Table). Conclusion: Patients with age > 65 years, diabetes mellitus, ESLD and a LVEF <50% were found to be at increased risk of myocardial injury within 1 year of a NSE. These characteristics should be accounted for during the interpretation of SE as these patients warrant intensive risk factor modification and close follow-up.