Abstract 1859: Stress Echocardiography can Risk Stratify and Prognosticate Patients With Left Ventricular Hypertrophy
Background: Left ventricular hypertrophy (LVH) is a marker for adverse cardiovascular outcomes. However, the role of stress echocardiography for risk stratification and prognosis of patients with LVH is limited.
Methods: We evaluated 1112 patients (mean age 62 ± 13 years, 35% men) with LVH (defined by LV mass index >134 g/m2 for men and 110 g/m2 for women). LV mass was calculated using the Troy’s formula (LV mass = 1.05[( LVEDD + IVS + PW)3 -LVEDD3]) which is recommended by the American Society of Echocardiography. Abnormal stress echo studies were defined as those with stress-induced ischemia. Followup (2.6 ± 1.0 years) for confirmed myocardial infarction (n = 28) and cardiac death (n = 44) were obtained.
Results: An abnormal stress echo portends a 4.5 times higher event rate compared to normal stress echo study (Event rate 4.5%/ y vs. 1.0%/y; OR = 4.9 95% CI = 2.8 – 8.6, P <0.0001). A forward conditional cox proportional regression model showed that stress echocardiography provided incremental prognostic value over clinical, stress EKG and rest echocardiography variables (Figure⇓). Age, basal heart rate, positive stress EKG response, lower ejection fraction and ischemia on stress echocardiogram were significant multivariable predictors of hard events.
Conclusions: Stress echocardiography effectively risk stratifies and provides incremental prognostic value over clinical, stress EKG and rest echocardiographic variables even in patients with LVH. A normal study portends a benign prognosis while ishemia on stress echo is a strong predictor of future cardiovascular events. Stress echocardiography should be routinely used in the prognostic model for patients with LVH.