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Rev Esp Cardiol (Engl Ed). 2017 Sep;70(9):736-743. doi: 10.1016/j.rec.2016.11.040. Epub 2017 Apr 14.

Influence of Cardiovascular Risk in the Prediction and Timing of Cardiac Events After Exercise Echocardiogram Testing Without Ischemia.

[Article in English, Spanish]

Author information

Servicio de Cardiología, Hospital de Galdakao, Galdakao, Vizcaya, Spain. Electronic address:
Unidad de Investigación, Hospital de Galdakao, Galdakao, Vizcaya, Spain.
Servicio de Cardiología, Hospital de Galdakao, Galdakao, Vizcaya, Spain.



There have been no analyses of the influence of cardiovascular risk as a predictor of events in patients with exercise echocardiography (EE) without ischemia. Our objective was to determine the predictors of cardiac events, paying special attention to cardiovascular risk.


This study included 1640 patients with EE without ischemia. Of these, there were 1206 with no previously known coronary artery disease (CAD), whose risk of a fatal cardiovascular disease event was estimated according to the European SCORE (Systematic COronary Risk Evaluation) risk assessment system, and 434 with known CAD. The primary endpoint was cardiac event-free survival (EFS) (cardiac death, nonfatal acute coronary syndrome, and coronary revascularization).


After a median follow-up of 35 [23-54] months, no differences were found in cardiac EFS between patients with a SCORE ≥ 10 or diabetes and patients with previous CAD (89.8% vs 87.1%). In the first year, cardiac EFS was high in all groups (99.4% if SCORE < 5; 100% if 5-9; 98% if ≥ 10 or diabetes and 97% in patients with CAD). In the third year, cardiac EFS was similar in the group with SCORE ≥ 10 or diabetes (94.5%) and patients with CAD (91.1%, P = NS). In these patients, the annualized event rate was 2.8% and 2.55%, respectively, and was significantly higher than in groups with SCORE < 5 (0.6%) and SCORE 5-9 (0.12%). The most frequent events were non-ST-segment elevation acute coronary syndrome and late revascularization. Predictors of cardiac events were previous CAD, SCORE ≥ 10 or diabetes mellitus, creatinine clearance, left ventricular ejection fraction, and chest pain during EE.


Initial outcome after an EE without ischemia is favorable but is subsequently modulated by cardiovascular risk.


Cardiovascular risk; Ecocardiografía de esfuerzo; Ecocardiografía de estrés; Exercise echocardiography; Prognosis; Pronóstico; Riesgo cardiovascular; Stress echocardiography

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