TY - JOUR
T1 - Outcome after abnormal exercise echocardiography for patients with good exercise capacity
T2 - Prognostic importance of the extent and severity of exercise-related left ventricular dysfunction
AU - McCully, Robert B.
AU - Roger, Veronique L.
AU - Mahoney, Douglas W.
AU - Burger, Kelli N.
AU - Click, Roger L.
AU - Seward, James B.
AU - Pellikka, Patricia A.
PY - 2002/4/17
Y1 - 2002/4/17
N2 - OBJECTIVES: We sought to define the prognostic implications of the extent and severity of exercise echocardiographic abnormalities in patients with good exercise capacity. BACKGROUND: The exercise capacity of patients with known or suspected coronary artery disease (CAD) is of prognostic importance, as is the extent of exercise-related left ventricular (LV) hypoperfusion or dysfunction. METHODS: We examined the outcomes of 1,874 patients with known or suspected CAD (mean age 64 ± 10 years, 64% men) who had good exercise capacity (≥5 metabolic equivalents [METs] for women, ≥7 METs for men) but abnormal exercise echocardiograms and analyzed the potential association between clinical, exercise and echocardiographic variables and subsequent cardiac events. RESULTS: Multivariate predictors of time to cardiac death or nonfatal myocardial infarction (MI) were diabetes mellitus (risk ratio [RR] 1.88; 95% confidence interval [CI] 1.2 to 3.0), history of MI (RR 2.44; 95% CI 1.6 to 3.6) and an increase or no change in LV end-systolic size in response to exercise (RR 1.61; 95% CI 1.1 to 2.5). Using echocardiographic variables that were of incremental prognostic value, we were able to stratify the cardiac risk of the study population; cardiac death or nonfatal MI rate per person-year of follow-up was 1.6% for patients who had a decrease in LV end-systolic size in response to exercise (n = 1,330) and 1.2% for patients who did not have any severely abnormal LV segments immediately after exercise (n = 868). CONCLUSIONS: In patients with good exercise capacity, echocardiographic descriptors of the extent and severity of exercise-related LV dysfunction were of independent and incremental prognostic value. Stratification of patients into low- and higher risk subgroups was possible using these exercise echocardiographic characteristics.
AB - OBJECTIVES: We sought to define the prognostic implications of the extent and severity of exercise echocardiographic abnormalities in patients with good exercise capacity. BACKGROUND: The exercise capacity of patients with known or suspected coronary artery disease (CAD) is of prognostic importance, as is the extent of exercise-related left ventricular (LV) hypoperfusion or dysfunction. METHODS: We examined the outcomes of 1,874 patients with known or suspected CAD (mean age 64 ± 10 years, 64% men) who had good exercise capacity (≥5 metabolic equivalents [METs] for women, ≥7 METs for men) but abnormal exercise echocardiograms and analyzed the potential association between clinical, exercise and echocardiographic variables and subsequent cardiac events. RESULTS: Multivariate predictors of time to cardiac death or nonfatal myocardial infarction (MI) were diabetes mellitus (risk ratio [RR] 1.88; 95% confidence interval [CI] 1.2 to 3.0), history of MI (RR 2.44; 95% CI 1.6 to 3.6) and an increase or no change in LV end-systolic size in response to exercise (RR 1.61; 95% CI 1.1 to 2.5). Using echocardiographic variables that were of incremental prognostic value, we were able to stratify the cardiac risk of the study population; cardiac death or nonfatal MI rate per person-year of follow-up was 1.6% for patients who had a decrease in LV end-systolic size in response to exercise (n = 1,330) and 1.2% for patients who did not have any severely abnormal LV segments immediately after exercise (n = 868). CONCLUSIONS: In patients with good exercise capacity, echocardiographic descriptors of the extent and severity of exercise-related LV dysfunction were of independent and incremental prognostic value. Stratification of patients into low- and higher risk subgroups was possible using these exercise echocardiographic characteristics.
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U2 - 10.1016/S0735-1097(02)01778-3
DO - 10.1016/S0735-1097(02)01778-3
M3 - Article
C2 - 11955853
AN - SCOPUS:0037123149
SN - 0735-1097
VL - 39
SP - 1345
EP - 1352
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 8
ER -