Prognostic value of exercise echocardiography: Validation of a new risk index combining echocardiographic, treadmill, and exercise electrocardiographic parameters

Wojciech Mazur, Jose M. Rivera, Alexander F. Khoury, Abhijeet G. Basu, Alejandro Perez-Verdia, Gary F. Marks, Su-Min Chang, Leopoldo Olmos, Miguel A. Quiñones, William A. Zoghbi

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

Exercise (Ex) echocardiography has been shown to have significant prognostic power, independent of other known predictors of risk from an Ex stress test. The purpose of this study was to evaluate a risk index, incorporating echocardiographic and conventional Ex variables, for a more comprehensive risk stratification and identification of a very low-risk group. Two consecutive, mutually exclusive populations referred for treadmill Ex echocardiography with the Bruce protocol were investigated: hypothesis-generating (388 patients; 268 males; age 55 ± 13 years) and hypothesis-testing (105 patients; 61 males age: 54 ± 14 years). Cardiac events included cardiac death, myocardial infarction, late revascularization (>90 days), hospital admission for unstable angina, and admission for heart failure. Mean follow-up in the hypothesis-generating population was 3.1 years. There were 38 cardiac events. Independent predictors of events by multivariate analysis were: Ex wall motion score index (odds ratio [OR] = 2.77/Unit; P < .001); ischemic S-T depression ≥ 1 mm (OR = 2.84; P = .002); and treadmill time (OR = 0.87/min; P = .037). A risk index was generated on the basis of the multivariate Cox regression model as: risk index = 1.02 (Ex wall motion score index) + 1.04 (S-T change) -0.14 (treadmill time). The validity of this index was tested in the hypothesis-testing population. Event rates at 3 years were lowest (0%) in the lower quartile of risk index (-1.22 to -0.47), highest (29.6%) in the upper quartile (+0.66 to +2.02), and intermediate (19.2% to 15.3%) in the intermediate quartiles. The OR of the risk index for predicting cardiac events was 2.94/Unit ([95% confidence interval: 1.4 to 6.2]; P = .0043). Echocardiographic and Ex parameters are independent powerful predictors of cardiac events after treadmill stress testing. A risk index can be derived with these parameters for a more comprehensive risk stratification with Ex echocardiography.

Original languageEnglish (US)
Pages (from-to)318-325
Number of pages8
JournalJournal of the American Society of Echocardiography
Volume16
Issue number4
DOIs
StatePublished - Apr 1 2003

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Prognostic value of exercise echocardiography: Validation of a new risk index combining echocardiographic, treadmill, and exercise electrocardiographic parameters'. Together they form a unique fingerprint.

Cite this