Long-term prognostic value of exercise echocardiography compared with exercise 201Tl, ECG, and clinical variables in patients evaluated for coronary artery disease

Leopoldo I. Olmos, Habib Dakik, Richard Gordon, J. Kay Dunn, Mario S. Verani, Miguel A. Quiñones, William A. Zoghbi

Research output: Contribution to journalArticle

119 Scopus citations

Abstract

Background - The accuracy of exercise echocardiography and 201Tl single photon emission computed tomography (SPECT) is similar in the diagnosis of coronary artery disease (CAD). However, comparative data on long-term prognosis are lacking. Methods and Results - Clinical variables and exercise, echocardiographic, and 201Tl tomographic parameters were studied in 248 patients (age, 56±12 years [mean±SD]; 189 men) who underwent simultaneous treadmill exercise 201Tl SPECT and echocardiography. Follow- up was obtained in 225 patients (91%) at a mean of 3.7±2.0 years. A total of 64 cardiac events occurred. With the use of stepwise logistic regression, 4 models simulating clinical Stress testing scenarios were evaluated in the prediction of all cardiac events, ischemic events, and/or cardiac death. The best clinical models were exercise echocardiography with exercise ECG and exercise 201Tl SPECT with exercise ECG. Both models were comparable in the prediction of cardiac events. For the exercise echocardiography model, exercise wall motion score index and induction of ischemia were the strongest predictors of events with ORs of 2.63 per unit treatment (95% CI, 1.34 to 5.17; P=0.005) and 4.1 (95% CI, 1.32 to 12.79; P=0.015), respectively. For the model with exercise 201Tl SPECT, the strongest predictor was ischemic perfusion defect (OR, 4.93; 95% CI, 1.72 to 14.08; P=0.003). The absence of ST changes during exercise decreased the risk of events. For the prediction of ischemic events and/or cardiac death, echocardiographic and 201Tl parameters were the only predictive variables. Conclusions - In patients evaluated for CAD, exercise echocardiography and 201Tl combined with ECG variables provide comparable prognostic information and can be used interchangeably for risk stratification.

Original languageEnglish (US)
Pages (from-to)2679-2686
Number of pages8
JournalCirculation
Volume98
Issue number24
DOIs
StatePublished - Dec 15 1998

Keywords

  • Coronary disease
  • Echocardiography
  • Imaging
  • Ischemia
  • Prognosis

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

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