TY - JOUR
T1 - Exercise echocardiographic findings and outcome of patients referred for evaluation of dyspnea
AU - Bergeron, Sébastien
AU - Ommen, Steve R.
AU - Bailey, Kent R.
AU - Oh, Jae K.
AU - McCully, Robert B.
AU - Pellikka, Patricia A.
PY - 2004/6/16
Y1 - 2004/6/16
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.
KW - CAD
KW - EF
KW - HR
KW - MI
KW - NYHA
KW - New York Heart Association
KW - WMSI
KW - coronary artery disease
KW - ejection fraction
KW - hazard ratio
KW - myocardial infarction
KW - wall motion score index
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U2 - 10.1016/j.jacc.2004.03.033
DO - 10.1016/j.jacc.2004.03.033
M3 - Article
C2 - 15193687
AN - SCOPUS:2942543109
SN - 0735-1097
VL - 43
SP - 2242
EP - 2246
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 12
ER -