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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

1
Servicio de Cardiología, Hospital de Galdakao, Galdakao, Vizcaya, Spain. Electronic address: soniavelascodelcastillo@gmail.com.
2
Unidad de Investigación, Hospital de Galdakao, Galdakao, Vizcaya, Spain.
3
Servicio de Cardiología, Hospital de Galdakao, Galdakao, Vizcaya, Spain.

Abstract

INTRODUCTION AND OBJECTIVES:

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.

METHODS:

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).

RESULTS:

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.

CONCLUSIONS:

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

KEYWORDS:

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

PMID:
28416165
DOI:
10.1016/j.rec.2016.11.040
[Indexed for MEDLINE]

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