The prognostic role of stress echocardiography in a contemporary population and the clinical significance of limited apical ischaemia

Alexandros Papachristidis, Damian Roper, Daniela Cassar Demarco, Ioannis Tsironis, Michael Papitsas, Jonathan Byrne, Khaled Alfakih, Mark J. Monaghan

Stress echocardiography (SE) is an important tool to diagnose coronary artery disease (CAD) and guide patient management. In this study we aim to re-assess its predictive value with regards to patient outcomes in a contemporary population from a large volume tertiary center. 927 patients who underwent SE within a calendar year were included. Follow-up data with regards to MACCE were collected for a period of 12 months following the SE. Mortality data were recorded over 27.0±4.6 months (5.5-34.2 months). We sought to investigate predictors of MACCE and all-cause mortality. In 880 patients who had full demographic and follow-up data, male gender, previous history of CAD, impaired LV systolic dysfunction and the positive result of SE were correlated with MACCE in a univariable analysis. In a multi-variable model only the positive result of SE was found to be significantly related to MACCE (HR:3.71, p=0.012). Furthermore, the subgroup of patients with limited ischaemia had worse outcome compared to those with negative SE (HR:3.68, p=0.041). Only age (HR:1.07, p< 0.001) was correlated with all-cause mortality. Our study shows that SE remains a strong predictor of patients' outcome in a contemporary population. A positive SE result was the only predictor of 12-month MACCE. The subgroup of patients with limited apical ischaemia had 3.7-times higher risk of MACCE compared to patients with negative SE. A negative SE result warrants a very good prognosis with very low risk of MACCE (1%) and cardiac death (0%) within a year following the SE test.