Exercise echocardiographic findings and outcome of patients referred for evaluation of dyspnea

Sébastien Bergeron, Steve R. Ommen, Kent R Bailey, Jae Kuen Oh, Robert B. McCully, Patricia Pellikka

Research output: Contribution to journalArticle

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Abstract

Objectives The purpose of this study was to characterize the outcome of patients referred for exercise echocardiographic evaluation of dyspnea. Background Little information exists regarding outcome of patients with dyspnea. Methods We identified 443 patients with unexplained dyspnea, 2,033 with chest pain, and 587 with both symptoms referred for exercise echocardiography. Results Compared to those with chest pain alone, patients referred for dyspnea alone were older, predominately men, and had lower workload, lower ejection fraction (EF), more prior myocardial infarction (MI), and abnormal rest electrocardiograms. Patients with both symptoms were similar to those with dyspnea, but more had prior revascularization. Exercise echocardiography showed ischemia in 42% of patients with dyspnea, 19% with chest pain, and 58% with both symptoms. During 3.1 ± 1.8 years follow-up, cardiac death (5.2% vs. 0.9%, p < 0.0001) and nonfatal MI (4.7% vs. 2.0%, p < 0.0001) occurred more often in patients with dyspnea. Events in patients with both symptoms were similar to those with dyspnea, except for revascularization (20% vs. 13%, p = 0.0004). For patients with dyspnea, independent predictors of events were previous MI (hazard ratio [HR] 3.35, p < 0.0001), male gender (HR 1.94, p = 0.0252), EF (HR 0.95/10% increment, p < 0.0001), and increase in wall motion score index with exercise (HR 4.19/0.25 U, p < 0.0001), but not chest pain. Conclusions Patients with unexplained dyspnea have a high likelihood of ischemia and an increased incidence of cardiac events. Exercise echocardiography provides independent information for identifying patients at risk. In patients with known or suspected coronary artery disease, dyspnea is a symptom requiring investigation.

Original languageEnglish (US)
Pages (from-to)2242-2246
Number of pages5
JournalJournal of the American College of Cardiology
Volume43
Issue number12
DOIs
StatePublished - Jun 16 2004

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Dyspnea
Exercise
Chest Pain
Echocardiography
Myocardial Infarction
Ischemia
Workload
Coronary Artery Disease
Electrocardiography

Keywords

  • CAD
  • coronary artery disease
  • EF
  • ejection fraction
  • hazard ratio
  • HR
  • MI
  • myocardial infarction
  • New York Heart Association
  • NYHA
  • wall motion score index
  • WMSI

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Exercise echocardiographic findings and outcome of patients referred for evaluation of dyspnea. / Bergeron, Sébastien; Ommen, Steve R.; Bailey, Kent R; Oh, Jae Kuen; McCully, Robert B.; Pellikka, Patricia.

In: Journal of the American College of Cardiology, Vol. 43, No. 12, 16.06.2004, p. 2242-2246.

Research output: Contribution to journalArticle

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abstract = "Objectives The purpose of this study was to characterize the outcome of patients referred for exercise echocardiographic evaluation of dyspnea. Background Little information exists regarding outcome of patients with dyspnea. Methods We identified 443 patients with unexplained dyspnea, 2,033 with chest pain, and 587 with both symptoms referred for exercise echocardiography. Results Compared to those with chest pain alone, patients referred for dyspnea alone were older, predominately men, and had lower workload, lower ejection fraction (EF), more prior myocardial infarction (MI), and abnormal rest electrocardiograms. Patients with both symptoms were similar to those with dyspnea, but more had prior revascularization. Exercise echocardiography showed ischemia in 42{\%} of patients with dyspnea, 19{\%} with chest pain, and 58{\%} with both symptoms. During 3.1 ± 1.8 years follow-up, cardiac death (5.2{\%} vs. 0.9{\%}, p < 0.0001) and nonfatal MI (4.7{\%} vs. 2.0{\%}, p < 0.0001) occurred more often in patients with dyspnea. Events in patients with both symptoms were similar to those with dyspnea, except for revascularization (20{\%} vs. 13{\%}, p = 0.0004). For patients with dyspnea, independent predictors of events were previous MI (hazard ratio [HR] 3.35, p < 0.0001), male gender (HR 1.94, p = 0.0252), EF (HR 0.95/10{\%} increment, p < 0.0001), and increase in wall motion score index with exercise (HR 4.19/0.25 U, p < 0.0001), but not chest pain. Conclusions Patients with unexplained dyspnea have a high likelihood of ischemia and an increased incidence of cardiac events. Exercise echocardiography provides independent information for identifying patients at risk. In patients with known or suspected coronary artery disease, dyspnea is a symptom requiring investigation.",
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AU - Bergeron, Sébastien

AU - Ommen, Steve R.

AU - Bailey, Kent R

AU - Oh, Jae Kuen

AU - McCully, Robert B.

AU - Pellikka, Patricia

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N2 - Objectives The purpose of this study was to characterize the outcome of patients referred for exercise echocardiographic evaluation of dyspnea. Background Little information exists regarding outcome of patients with dyspnea. Methods We identified 443 patients with unexplained dyspnea, 2,033 with chest pain, and 587 with both symptoms referred for exercise echocardiography. Results Compared to those with chest pain alone, patients referred for dyspnea alone were older, predominately men, and had lower workload, lower ejection fraction (EF), more prior myocardial infarction (MI), and abnormal rest electrocardiograms. Patients with both symptoms were similar to those with dyspnea, but more had prior revascularization. Exercise echocardiography showed ischemia in 42% of patients with dyspnea, 19% with chest pain, and 58% with both symptoms. During 3.1 ± 1.8 years follow-up, cardiac death (5.2% vs. 0.9%, p < 0.0001) and nonfatal MI (4.7% vs. 2.0%, p < 0.0001) occurred more often in patients with dyspnea. Events in patients with both symptoms were similar to those with dyspnea, except for revascularization (20% vs. 13%, p = 0.0004). For patients with dyspnea, independent predictors of events were previous MI (hazard ratio [HR] 3.35, p < 0.0001), male gender (HR 1.94, p = 0.0252), EF (HR 0.95/10% increment, p < 0.0001), and increase in wall motion score index with exercise (HR 4.19/0.25 U, p < 0.0001), but not chest pain. Conclusions Patients with unexplained dyspnea have a high likelihood of ischemia and an increased incidence of cardiac events. Exercise echocardiography provides independent information for identifying patients at risk. In patients with known or suspected coronary artery disease, dyspnea is a symptom requiring investigation.

AB - Objectives The purpose of this study was to characterize the outcome of patients referred for exercise echocardiographic evaluation of dyspnea. Background Little information exists regarding outcome of patients with dyspnea. Methods We identified 443 patients with unexplained dyspnea, 2,033 with chest pain, and 587 with both symptoms referred for exercise echocardiography. Results Compared to those with chest pain alone, patients referred for dyspnea alone were older, predominately men, and had lower workload, lower ejection fraction (EF), more prior myocardial infarction (MI), and abnormal rest electrocardiograms. Patients with both symptoms were similar to those with dyspnea, but more had prior revascularization. Exercise echocardiography showed ischemia in 42% of patients with dyspnea, 19% with chest pain, and 58% with both symptoms. During 3.1 ± 1.8 years follow-up, cardiac death (5.2% vs. 0.9%, p < 0.0001) and nonfatal MI (4.7% vs. 2.0%, p < 0.0001) occurred more often in patients with dyspnea. Events in patients with both symptoms were similar to those with dyspnea, except for revascularization (20% vs. 13%, p = 0.0004). For patients with dyspnea, independent predictors of events were previous MI (hazard ratio [HR] 3.35, p < 0.0001), male gender (HR 1.94, p = 0.0252), EF (HR 0.95/10% increment, p < 0.0001), and increase in wall motion score index with exercise (HR 4.19/0.25 U, p < 0.0001), but not chest pain. Conclusions Patients with unexplained dyspnea have a high likelihood of ischemia and an increased incidence of cardiac events. Exercise echocardiography provides independent information for identifying patients at risk. In patients with known or suspected coronary artery disease, dyspnea is a symptom requiring investigation.

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KW - hazard ratio

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KW - myocardial infarction

KW - New York Heart Association

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KW - wall motion score index

KW - WMSI

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