Abstract
Purpose
The aims of this study were to evaluate the long-term prognostic value of stress echocardiography
(SE) in patients evaluated in emergency department (ED) and to determine SE parameters
that best predicted outcome.
Methods
Between June 2008 and July 2012, 626 patients with an episode of spontaneous chest
pain underwent SE (exercise stress echocardiography or dobutamine stress echocardiography
[DSE]). Between December 2012 and January 2013, all patients were contacted to verify
the occurrence of cardiac events. Patients were divided in 3 subgroups according to
peak stress Wall Motion Score Index (pWMSI): normal peak wall motion (pWMSI, 1; group
A1), mild to moderate peak asynergy (pWMSI, 1.1-1.7; group A2), and severe peak asynergy
(pWMSI, >1.7; group A3).
Results
Stress echocardiography showed inducible ischemia in 159 patients (25%); it was negative
in 425 (68%) and inconclusive in 42 (7%). Patients with cardiac events more frequently
showed inducible ischemia (50% vs 26%; P = .015) compared with patients with good prognosis; a normal SE (14% vs 61%) was
significantly less common. At a multivariate regression analysis, an increased pWMSI
(relative risk: 9.816, 95% confidence interval: 3.665-26.290; P < .0001) was independently associated with a bad outcome. Cumulative event-free survival
was significantly worse with an increasing degree of peak wall motion asynergy (99%
in group A1; 96%, group A2; and 88% in group A3; P = .011 between A1 and A2 groups, P = .012 between A2 and A3 groups, and P < .0001 between A1 and A3 groups).
Conclusions
Stress echocardiography showed an optimal prognostic value among ED patients evaluated
for chest pain. The presence of an extensive asynergic area at peak stress was associated
with an adverse prognosis.
To read this article in full you will need to make a payment
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Testing of low-risk patients presenting to the emergency department with chest pain: a scientific statement from the American Heart Association.Circulation. 2010; 122: 1756-1776
- Trends in presenting characteristics and hospital mortality in patients with ST-elevation and non-ST-elevation myocardial infarction in the national registry of myocardial infarction from 1990-2006.J Am Coll Cardiol. 2008; 51: A217
- ESC guidelines concerning proceedings in stable coronary artery disease in 2013.Kardiol Pol. 2013; 71: S243-S317
- Stress echocardiography is superior to exercise ECG in the risk stratification of patients presenting with acute chest pain with negative troponin.Eur J Echocardiogr. 2006; 7: 155-164
- Stress function index, a novel index for risk stratification and prognosis using stress echocardiography.J Am Soc Echocardiogr. 2005; 18: 1335-1342
- Stress echo results predict mortality: a large-scale multicenter prospective international study.J Am Coll Cardiol. 2003; 41: 589-595
- Assessment of patients with low-risk chest pain in the emergency department: head-to-head comparison of exercise stress echocardiography and exercise myocardial SPECT.Am Heart J. 2005; 149: 894-901
- A new simple risk score in patients with acute chest pain without existing known coronary disease.Am J Emerg Med. 2010; 28: 135-142
- Stress echocardiography: current methodology and clinical applications.J Am Coll Cardiol. 2005; 45: 1739-1747
- Clinical and economic impact of stress echocardiography compared with exercise electrocardiography in patients with suspected acute coronary syndrome but negative troponin: a prospective randomized controlled study.Eur Heart J. 2007; 28: 204-211
- Echocardiography to supplement stress electrocardiography in emergency department chest pain patients.West J Emerg Med. 2010; 11: 379-383
- Prognostic value of predischarge dobutamine stress echocardiography in chest pain patients with a negative cardiac troponin T.J Am Coll Cardiol. 2003; 41: 596-602
- The prognostic value of normal exercise myocardial perfusion imaging and exercise echocardiography: a meta-analysis.J Am Coll Cardiol. 2007; 49: 227-237
- Prediction of mortality and major cardiac events by exercise echocardiography in patients with normal exercise electrocardiographic testing.J Am Coll Cardiol. 2009; 53: 1981-1990
- Outcomes after normal dobutamine stress echocardiography and predictors of adverse events: long-term follow-up of 3014 patients.Eur Heart J. 2006; 27: 3039-3044
- Stress echocardiography in the ED: diagnostic performance in high-risk subgroups.Am J Emerg Med. 2013; 31: 1309-1314
Article Info
Publication History
Published online: March 28, 2014
Accepted:
March 20,
2014
Received in revised form:
March 10,
2014
Received:
January 31,
2014
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
