Abstract 606: Prognostic Implication Of Stress Echocardiography Result In Hypertensives And Normotensives. A Study On 10,054 Patients
Background. The relative prognostic meaning of stress echocardiography (SE) result in hypertensives (H) and normotensives (N) remains to be addressed.
Aim. To compare the prognostic implication of SE in a large cohort of H and N with known or suspected coronary artery disease (CAD).
Methods. The study group was formed by 10,054 patients (5,355 H and 4,699 N) who underwent exercise (n=536), dobutamine (n=2,007) or dipyridamole (n=7,511) SE for evaluation of known (n=4,075) or suspected (n=5,979) CAD. Patients were followed-up for a median of 24.4 months.
Results. Ischemia at SE was assessed in 2,873 patients. During follow-up, 1,391 events (782 deaths, 609 infarctions) occurred. Independent prognostic indicators were ischemia at SE (HR 2.67, CI 2.30 –3.11, p<0.0001), resting wall motion abnormality (RWMA) (HR 1.41, CI 1.21–1.65, p<0.0001), diabetes (HR 1.55, CI 1.32–1.82, p<0.0001), age (HR 1.03, CI 1.02–1.04, p<0.0001), male sex (HR 1.26, CI 1.08 –1.48, p=0.003), left bundle branch block (HR 1.55, CI 1.13–2.12, p=0.006), and prior angioplasty (HR 1.26, CI 1.04 –1.52, p=0.02) in H, and ischemia at SE (HR 1.41, CI 1.19 –1.67, p<0.0001), peak wall motion score index (HR 2.57, CI 2.00 –3.29, p<0.0001), diabetes (HR 1.84, CI 1.52–2.24, p<0.0001), age (HR 1.04, CI 1.03–1.05, p<0.0001), RWMA (HR 1.36, CI 1.09 –1.69, p=0.007), and male sex (HR 1.27, CI 1.06 –1.53, p=0.01) in N. Annual event rate was markedly higher in H than in N with no ischemia and no RWMA (2.6% and 1.6%, p<0.0001): figure⇓.
Conclusions. SE result allows effective prognostication in H and N. However, a non ischemic test predicts better survival in N than in H with no RWMA.