Resting abnormalities encountered in stress echocardiography predict long-term outcomes among patients admitted for chest pain

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Patients hospitalized with chest pain frequently undergo stress echocardiography for detecting inducible ischemia, but other cardiac pathology is often noted on rest imaging. The long term significance of these findings is not well studied. We hypothesized that such findings indicative of cardiovascular pathology on the resting portion of a stress echocardiogram have prognostic significance for patients admitted with chest pain. Methods We examined patients admitted with chest pain at an academic tertiary care medical center over a 2-year period who had stress echocardiography as the primary diagnostic test. Patients admitted with heart failure symptoms or syncope or patients referred for presurgical/prerehabilitation clearance were excluded. Resting and stress echocardiograms were evaluated by cardiologists with board-certification in echocardiography, and resting abnormalities were analyzed for any effect on cardiovascular outcomes, assessed over 3 years of follow up. Survival of patients with echocardiographic abnormalities on the resting study (resting wall motion abnormalities) was compared with an age- and sex-matched cohort of admitted chest pain patients without resting abnormalities. Results A total of 587 patients met inclusion criteria, and 198 (34%) had resting echocardiographic abnormalities. The most common abnormality involved the left ventricle. Left ventricular hypertrophy (LVH) was seen in 16% (96), and resting wall abnormalities were seen in 15% (90); among the 90 patients with resting wall motion abnormalities, segmental wall motion abnormality was seen in 57 (9.7% of total sample), and global LV dysfunction was seen in 33 (5.6% of total sample). LVH in the absence of hypertension was found in 5% (28), raising the diagnostic possibility of hypertrophic cardiomyopathy. Moderate or greater left heart valvular abnormalities were found in 3% (18). Abnormal pericardial effusions greater than mild (excluding trivial effusion) were found in 3 patients (0.5%), and pulmonary hypertension was detected in 13 patients (2%). At 3-year follow-up, patients with resting wall motion abnormalities were found to have a higher mortality than an age and sex-matched cohort of chest pain patients without these abnormalities at rest; 85% vs. 97%, p<0.015. Conclusions In patients hospitalized for chest pain, cardiac diagnoses with prognostic significance are often detected on the resting echocardiographic examination. These abnormalities offer insight into outcomes, given their propensity to determine mortality three years post admission, and an opportunity to institute adequate therapy that alters adverse outcomes.