Abstract 13950: Risk Stratification and Prognostic Value of Stress Echocardiography in Patients with Intermediate Framingham Risk Scores
Background: Management of cardiovascular disease risk in patients with intermediate risk (Framingham score, FRS 10-20%) is controversial. The purpose of this study was to evaluate the potential role of stress echocardiography (SEcho) in risk stratification and prognosis of patients with intermediate FRS.
Methods: We evaluated 905 patients (53 ± 8 years; 29% male) with intermediate FRS (10-20%) who underwent SEcho. Resting left ventricular ejection fraction and regional wall motion were assessed. The left ventricle was divided into 16 segments and scored on a 5-point scale of wall motion. Abnormal SEcho was defined as stress-induced ischemia (wall-motion score of ≥1 grade). Follow-up (3.4 ± 1.5 years) for non-fatal myocardial infarction (n = 21) and cardiac death (n = 15) were obtained.
Results: By univariate analysis, abnormal resting electrocardiogram (p<0.001) and new ischemic wall motion abnormalities (p<0.001) were significant predictors of cardiac events. Cumulative survival in patients with intermediate range FRS was significantly worse in patients with abnormal (ischemic) vs. normal (nonischemic) SEcho (3.2%/year vs. 0.52%/year, p<0.001)(Graph).Multivariate Cox proportional hazards analysis identified new ischemic wall motion abnormalities as the strongest predictor of cardiac events (HR 3.3, 95% CI 1.4-7.8, p=0.006).
Conclusions: In patients with intermediate Framingham Risk Score, stress echocardiography results were able to effectively risk stratify patients into intermediate (abnormal, 3.2%/year) and low (normal, 0.52%/year) cardiac risk groups.
- © 2012 by American Heart Association, Inc.