Abstract 17621: Octogenarians Who Can Exercise During Stress Testing Have Better Outcomes: A Stress Echocardiography Study

Abstract

Background Octogenarians are often referred for stress testing due to high prevalence of coronary artery disease (CAD), multiple medical co-morbidities and atypical manifestations of CAD. However, there is limited data on the prognostic value of stress echocardiography (SE) in this group. Methods Consecutive patients ≥ 80 years of age referred for SE between 2000-2006 for various indications at a tertiary care medical center formed the study cohort. Demographics, CAD risk factors, mode of stress, resting and stress ECG and echocardiographic parameters were evaluated. The left ventricle was divided into the 16-segment model as per the American Society of Echocardiography. Each segment was scored on a 5-point scale. Ischemia was defined as new wall motion abnormality or a biphasic response. All cause mortality was obtained via clinical follow up and confirmed in the social security death index. Results Overall, 572 patients (85 +/- 4.2 years, 65% women) with a mean follow up of 5.6 +/- 3 years were included in the analysis. There were 383 (67%) all cause deaths (annual rate 33 [13%] deaths/year) reported over the study duration. 53 (9%) patients underwent treadmill testing with the rest undergoing pharmacological testing. There was no difference in age, gender, and CAD risk factors in those undergoing exercise compared to pharmacological tests. Patients who underwent pharmacological testing had higher mortality, 359 vs 24 (69% vs 45%, p<0.001) deaths overall and annual mortality 31 vs 2 (14% vs 6%) deaths/year. After adjusting for age, gender, CAD risk factors, resting ejection fraction and ischemia, exercise was associated with lower all cause mortality, HR 0.52 (0.34 - 0.8, p=0.003) [figure]. Compared to pharmacological testing, patients who exercised experienced a median post test survival of 9.5 vs 5.9 years (p<0.001). Conclusions In octogenarians referred for SE, just the ability to perform treadmill exercise portends a benign prognosis.