Authors:
A. Bouzas Mosquera¹, J. Peteiro¹, F.J. Broullon Molanes¹, N. Alvarez Garcia¹, L. Garcia Bueno¹, L. Ferro¹, B. Bouzas Zubeldia¹, R. Perez Fernandez¹, R. Fabregas¹, A. Castro Beiras¹, ¹Juan Canalejo Hospital - A Coruna - Spain,

Purpose: To assess the value of exercise echocardiography (EE) for predicting long-term mortality in patients with known or suspected coronary artery disease and normal exercise electrocardiogram (ECG) testing.

Methods: We studied 4004 consecutive patients (2358 men, mean age [± SD] 59.6±12.5 years) with interpretable ECG who underwent treadmill EE and did not develop chest pain or ischemic ECG changes during the test. Wall motion score index (WMSI) was evaluated at rest and at peak exercise, and the difference (ΔWMSI) was calculated. A positive EE was defined as the development of new or worsening wall motion abnormalities with exercise (ΔWMSI >0). The end-point was all-cause mortality.

Results: Overall, 669 patients (16.7%) developed new or worsening wall motion abnormalities. During a median follow-up of 1.94 years (range 1 to 4630 days), 288 patients died. The 5-year survival rate was 84.1% in patients with positive EE vs 91.3% in those with negative EE. Multivariate predictors of mortality were male sex (hazard ratio [HR] 2.48, 95% confidence interval [CI] 1.90-3.24, p <0.001), age (HR 1.04, 95% CI 1.02-1.05, p <0.001), hypertension (HR 1.25, 95% CI 0.98-1.60, p =0.08), resting WMSI (HR 1.80, 95% CI 1.22-2.64, p =0.003), metabolic equivalents (HR 0.80, 95% CI 0.77-0.83, p <0.001) and ΔWMSI (HR 2.50, 95% CI 1.22-5.10, p =0.012). The addition of the EE results to the clinical, resting echocardiographic and exercise ECG testing variables provided significant incremental prognostic information for predicting mortality (chi-square increase from 181 to 191, p =0.016).

Conclusion: EE has incremental value over clinical, resting echocardiographic and treadmill exercise variables for predicting mortality in patients with known or suspected coronary artery disease and normal exercise ECG testing.