Abstract
Abstract Introduction The exercise stress echocardiogram is a highly valuable tool for evaluating patients with dyspnea as the main symptom (without angina) and suspected coronary artery disease (CAD). This involves a large volume of patients in daily practice, and etiological orientation is often difficult, especially in patients with high cardiovascular risk. Objective This study aims to define the likelihood of inducible ischemia in this population concerning their pretest probability described in the literature, as well as to compare the exercise workload achieved during the test with the predicted workload. Methods We performed a retrospective analysis of 116 consecutive diagnostic exercise stress echocardiograms (2021-2023) conducted on patients with dyspnea as the main symptom (14.55% of the total exercise stress echocardiograms). Results The average age was 67.93 years (standard deviation [SD] 9.99), and the average body mass index (BMI) was 28.87 (SD 4.37). Baseline characteristics included hypertension (79 patients, 68.1%), diabetes (39 patients, 33.6%), dyslipidemia (76 patients, 65.5%), smoking (46 patients, 39.7%), and known pulmonary disease (21 patients, 18.1%). Among the patients, 104 (89.7%) had an intermediate pretest probability of CAD. The main reason for test termination was dyspnea in 78 patients (67.2%). The average maximum workload achieved was 7.28 METs (SD 2.34), compared to a predicted maximum workload of 6.58 METs (SD 1.78), resulting in an actual/predicted METs ratio of 1.14. The stress echocardiogram was positive for inducible ischemia in 8 cases (6.9%), with no significant differences between diabetic and non-diabetic patients (6.49% positive in non-diabetics, 7.89% positive in diabetics, p = 0.781). Conclusions Patients referred for dyspnea as the main symptom demonstrated greater functional capacity than predicted, suggesting both a challenging assessment of functional class in clinical consultations and a possible underestimation of age-predicted functional capacity formulas in the current population. Additionally, the positivity rate for ischemia was lower than described in the literature for a population with predominantly intermediate pretest probability of CAD. Salgo le characteristics
Published Version
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