Abstract
IntroductionIn this study, we aim to reassess the prognostic value of stress echocardiography (SE) in a contemporary population and to evaluate the clinical significance of limited apical ischaemia, which has not been previously studied.MethodsWe included 880 patients who underwent SE. Follow-up data with regards to MACCE (cardiac death, myocardial infarction, any repeat revascularisation and cerebrovascular accident) were collected over 12 months after the SE. Mortality data were recorded over 27.02 ± 4.6 months (5.5–34.2 months). We sought to investigate the predictors of MACCE and all-cause mortality.ResultsIn a multivariable analysis, only the positive result of SE was predictive of MACCE (HR, 3.71; P = 0.012). The positive SE group was divided into 2 subgroups: (a) inducible ischaemia limited to the apical segments (‘apical ischaemia’) and (b) ischaemia in any other segments with or without apical involvement (‘other positive’). The subgroup of patients with apical ischaemia had a significantly worse outcome compared to the patients with a negative SE (HR, 3.68; P = 0.041) but a similar outcome to the ‘other positive’ subgroup. However, when investigated with invasive coronary angiography, the prevalence of coronary artery disease (CAD) and their rate of revascularisation was considerably lower. Only age (HR, 1.07; P < 0.001) was correlated with all-cause mortality.ConclusionSE remains a strong predictor of patients’ outcome in a contemporary population. A positive SE result was the only predictor of 12-month MACCE. The subgroup of patients with limited apical ischaemia have similar outcome to patients with ischaemia in other segments despite a lower prevalence of CAD and a lower revascularisation rate.
Highlights
In this study, we aim to reassess the prognostic value of stress echocardiography (SE) in a contemporary population and to evaluate the clinical significance of limited apical ischaemia, which has not been previously studied
The SE result was found to be the only predictor of Major Adverse Cardiac and Cerebrovascular Events (MACCE) again (P = 0.042). Both subgroups of apical ischaemia and the remaining positive SE tests had worse outcome with regards to MACCE when compared to patients with a negative SE (HR: 3.68; 95% CI: 1.06–12.78; P = 0.041 and heart rate (HR): 3.72; 95% CI: 1.25–11.11, P = 0.019, respectively)
That risk is independent of other cardiovascular risk factors and remains the only predictor of MACCE after adjustment for all variables, (b) the patients with a negative SE are in a very low risk of MACCE (1%) and cardiac death (0%) within a year after the SE test and (c) the subgroup of patients with limited apical ischaemia have worse outcome compared to patients with negative SE but similar outcome compared to patients with inducible ischaemia in other segments
Summary
We aim to reassess the prognostic value of stress echocardiography (SE) in a contemporary population and to evaluate the clinical significance of limited apical ischaemia, which has not been previously studied. The subgroup of patients with limited apical ischaemia have similar outcome to patients with ischaemia in other segments despite a lower prevalence of CAD and a lower revascularisation rate. Stress echocardiography (SE) is an established and widely used imaging functional test It is included in most guidelines for the investigation of chest pain [1]. It is used in the risk stratification of patients with known coronary artery disease (CAD) [2], valvular heart disease [3], pre-operative assessment [4] and in the. We assess the clinical significance of limited apical ischaemia and its correlation with angiographic findings
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
