Independent and incremental prognostic value of exercise stress echocardiography in low cardiovascular risk female patients with chest pain

Echocardiography. 2017 Jan;34(1):69-77. doi: 10.1111/echo.13388. Epub 2016 Sep 30.

Abstract

Background: Exercise stress echocardiography (ESEcho) is sufficiently sensitive and has high enough specificity for the clinical detection of coronary artery disease (CAD) in women. However, there was little data about the ability of ESEcho to detect CAD and predict clinical outcomes in female patients with chest pain and low global cardiovascular (CV) risks. The purposes of this study were (1) to determine the diagnostic accuracy of ESEcho, (2) to evaluate the clinical outcomes of major cardiovascular outcome (MACE), and (3) to assess the incremental prognostic value of ESEcho for the prediction of MACE in Korean female patients with low CV risks.

Methods: Over a period of 15 years, 3396 patients (57±10 years) female patients with chest pain but no previous history of CAD undergoing ESEcho and exercise stress electrocardiography (ESECG) were assessed.

Results: During a median follow-up period of 4.8 years (2.8-6.2 years), there were 19 (0.61%) MACE. Positive results for ESEcho were seen in 134 patients (3.9%). The sensitivity and specificity of ESEcho were 66.7% and 84.8%, respectively. Positive ESEcho was an independent predictor of MACE (multivariate hazard ratio: 0.019, 95% CI: 0.004-0.081). ESEcho was incremental to clinical and ESECG parameters to predict the MACE in low CV risk women.

Conclusions: ESEcho is effective for the diagnosis of CAD in Korean female patients with chest pain, a population characterized by low cardiovascular risk profiles. Positive ESEcho was an independent predictor of MACE, and negative results were associated with favorable clinical outcomes. ESEcho was incremental to clinical and ESECG parameters to predict the MACE in low CV risk women.

Keywords: coronary artery disease; exercise echocardiography; female; stress echocardiography.

MeSH terms

  • Cardiovascular Diseases / diagnosis
  • Cardiovascular Diseases / epidemiology*
  • Chest Pain / diagnosis*
  • Chest Pain / epidemiology
  • Echocardiography, Stress / methods*
  • Electrocardiography
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Middle Aged
  • Predictive Value of Tests
  • Prognosis
  • Republic of Korea / epidemiology
  • Retrospective Studies
  • Risk Assessment / methods*
  • Risk Factors
  • Time Factors