Premium
Long‐term prognostic value of peak exercise echocardiogram in patients hospitalized with acute chest pain
Author(s) -
Merchan Ortega German,
Bonaque Gonzalez Juan Carlos,
Sanchez Espino Alejandro Dionisio,
Aguado Martin Maria Jose,
Navarro Garcia Francisco,
Ruiz Lopez Fuensanta,
Ramos Perales Francisco,
Zamorano Gomez Jose Luis
Publication year - 2017
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13530
Subject(s) - medicine , mace , cardiology , chest pain , coronary artery disease , myocardial infarction , timi , atrial fibrillation , acute coronary syndrome , incidence (geometry) , percutaneous coronary intervention , physics , optics
Peak exercise echocardiogram ( EE cho) has shown reasonable sensitivity and specificity in detecting significant coronary artery disease ( CAD ). The objective was to evaluate the prognostic value of EE cho in patients hospitalized for acute chest pain ( CP ) and its additional prognostic information regarding exercise electrocardiogram test ( EECG ). Methods Prospective observational study performed between May 2011 and September 2013, including 250 patients consecutively admitted for acute CP with normal cardiac biomarkers and nondiagnostic electrocardiogram. All patients were prospectively followed for 1 year, and major adverse cardiovascular events ( MACE ) were recorded: cardiac death, nonfatal myocardial infarction ( MI ), or angina with coronary revascularization. Results EE cho was positive in 16%. Patients with positive EE cho had a higher incidence of hypertension and higher TIMI risk score, showing significant CAD in 66%. We observed contradictory results ( EECG ‐ EE cho) in 20%. Patients with positive EE cho and negative EECG had significant CAD in the 66%, and patients undergoing coronary angiography with negative EE cho and positive EECG did not show significant coronary artery disease. Only positive EE cho ( P <.001, HR 0.169; 95% CI , 0.088–0.250) and atrial fibrillation ( P <.025, HR 0.125; 95% CI , 0.016–0.233) were independently associated with MACE during follow‐up. In patients with negative EE cho, the presence of MACE was 2%. Conclusions EE cho in patients hospitalized for acute chest pain presents good ability to diagnose acute coronary syndrome, while providing additional information when combined with an EECG in up to 20% of cases. Moreover, a negative EE cho in this cohort seems to provide prognostic information beyond the acute event to predict long‐term MACE .