Abstract 8885: Prognostic Significance of Dyspnea versus Chest Pain in Patients Referred for Stress Echocardiography
Background: Stress echo (SEcho) is an established modality for diagnosis and risk stratification of patients with known or suspected coronary artery disease. The purpose of this study was to examine the prognostic significance of dyspnea versus chest pain in patients referred for SEcho.
Methods: We evaluated 1335 patients (63 ± 13 years; 40% male) undergoing SEcho (49% treadmill, 51% dobutamine). Resting left ventricular ejection fraction and regional wall motion were assessed. The left ventricle was divided into 16 segments and scored on 5-point scale of wall motion. Abnormal SEcho was defined as stress-induced ischemia (wall-motion score of ≥1 grade). Followup (3.5 ± 1.5 years) for non-fatal myocardial infarction (n = 42) and cardiac death (n = 39) were obtained.
Results: By univariate analysis, both number of new ischemic wall motion abnormalities (p<0.0001) and ejection fraction (p<0.0001) were significant predictors of cardiac events. Cumulative survival was signficantly worse in patients with dyspnea vs. chest pain (2.3%/year vs. 1.4%/year, p=0.02). SEcho was further able to risk stratify normal (n = 289) vs. abnormal (n = 155) groups for dyspnea (1.0%/year vs. 4.4%/year; p < 0.001), and normal (n = 608) vs. abnormal (n = 283) groups for chest pain (0.8%/year vs. 2.9%/year; p < 0.001)(Figure). Multivariate logistic regression analysis identified number of new ischemic wall motion abnormalities as the strongest predictor of cardiac events (RR 1.7, 95% CI 1.0-2.9, p<0.05).
Conclusions: In patients referred for stress echocardiography, self-reported dyspnea identified a group of patients at increased risk for cardiac events. Stress echocardiography results (normal or abnormal) was further able to risk stratify both dyspnea and chest pain subgroups. Assessment of dyspnea should be incorporated into routine clinical evaluation of patients referred for stress echocardiography.
- © 2011 by American Heart Association, Inc.