Comparison of exercise echocardiography and the Duke treadmill score for risk stratification in patients with known or suspected coronary artery disease and normal resting electrocardiogram

Peteiro, Jesús; Monserrrat, Lorenzo; Piñeiro, Miriam; Calviño, Ramón; Vázquez, José Manuel; Mariñas, Javier; Castro‐Beiras, Alfonso

doi:10.1016/j.ahj.2006.03.015

Cited by 24 publications

(15 citation statements)

References 19 publications

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“…We have chosen a cutoff value of 3 ischemic segments to define extensive ischemia because this number is proportional to the 10% ischemic myocardium that has been considered for referring patients to revascularization to improve outcome. 19 Although we in the present work and others previously 5,6,9 have clearly demonstrated that patients achieving higher exercise workload have better clinical, exercise testing, and ExE results, there are still a significant number of subjects within this group in whom ischemia can be demonstrated. However, the low event rates in ischemic patients limit the usefulness of imaging for predicting outcome.…”

Section: Discussionmentioning

confidence: 69%

“…Patients with known CAD and patients who achieved <10 METs and <85% of their MAPHR were excluded because these individuals are at higher risk of events and imaging has previously demonstrated its usefulness in these patients. [7][8][9] Therefore, the final study population included 4269 patients ( Figure 1 Demographic and clinical data, as well as stress testing results, were entered in our database at the time of the procedures. The pretest probability of CAD was assessed according to the American College of Cardiology/American Heart Association guidelines on exercise testing.…”

Section: Patientsmentioning

confidence: 99%

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Value of an Exercise Workload ≥10 Metabolic Equivalents for Predicting Inducible Myocardial Ischemia

Peteiro

Bouzas‐Mosquera

Broullón

et al. 2013

Circ: Cardiovascular Imaging

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Background-We sought to identify extensive ischemia on exercise echocardiography (ExE) relative to workload in patients without known coronary artery disease and to investigate whether ExE is useful in predicting outcomes in those with high exercise capacity (≥10 metabolic equivalents [METs]) plus a maximal test (≥85% of their maximal age-predicted heart rate [MAPHR]). Methods and Results-The analysis was performed on 4269 patients who underwent ExE, of whom 3995 achieved ≥85% of their MAPHR. These patients were divided according to the reached workload (<7, 7-9, or ≥10 METs) and compared for ExE results. Outcomes in the group achieving ≥10 METs plus ≥85% of their MAPHR (n=2221) were specifically assessed. Ischemia was defined as new/worsening wall motion abnormalities with exercise. ExE results were different between groups because the METs were lower. Still, among patients achieving ≥10 METs plus ≥85% of their MAPHR, 9.3% had extensive ischemia and 6% multiterritory disease. During follow-up in this subgroup, 108 patients died and 42 had a major cardiac event. Annualized mortality and major cardiac event rates were 0.84% and 0.32% in patients without ischemia versus 2.26% and 0.84% in those with ischemia, respectively (P<0.001 and P=0.002, respectively). Ischemia was an independent predictor of mortality (hazard ratio,

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Section: Discussionmentioning

confidence: 69%

Section: Patientsmentioning

confidence: 99%

Value of an Exercise Workload ≥10 Metabolic Equivalents for Predicting Inducible Myocardial Ischemia

Peteiro

Bouzas‐Mosquera

Broullón

et al. 2013

Circ: Cardiovascular Imaging

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“…We have observed that ESE further catego- rizes patients with intermediate-risk Duke treadmill score into those at higher and lower risk of events. ESE also allows a better stratification of patients with low-risk Duke treadmill score, aiding in the decision whether to perform coronary angiography [26] . Several studies have shown that gender, functional capacity, rate-pressure product, resting LV function, and ischemia are independently associated with cardiac events [26,27] , and that ESE has incremental predictive value in patients with different pre-test probabilities of CAD [27] .…”

Section: Prognostic Value Of Exercise Echocardiographymentioning

confidence: 99%

“…ESE also allows a better stratification of patients with low-risk Duke treadmill score, aiding in the decision whether to perform coronary angiography [26] . Several studies have shown that gender, functional capacity, rate-pressure product, resting LV function, and ischemia are independently associated with cardiac events [26,27] , and that ESE has incremental predictive value in patients with different pre-test probabilities of CAD [27] . Patients with WMA involving the territories of the 3 coronary arteries, patients with peak wall motion score index > 1.5, and patients with ischemia at a distance are at higher risk for cardiac events [28] .…”

Section: Prognostic Value Of Exercise Echocardiographymentioning

confidence: 99%

“…ESE is particularly useful for prognostic assessment because exercise parameters with well-demonstrated prognostic value (such as metabolic equivalents achieved, blood pressure response, or percentage of age-predicted maximal heart rate) may be obtained. ESE has its maximal cost-effectiveness in the assessment of patients with intermediate likelihood of events [22,26] . We have observed that ESE further catego- rizes patients with intermediate-risk Duke treadmill score into those at higher and lower risk of events.…”

Section: Prognostic Value Of Exercise Echocardiographymentioning

confidence: 99%

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Exercise echocardiography

Peteiro

Bouzas‐Mosquera²

2010

WJC

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Exercise echocardiography has been used for 30 years. It is now considered a consolidated technique for the diagnosis and risk stratification of patients with known or suspected coronary artery disease (CAD). Of the stress echocardiography techniques, it represents the first choice for patients who are able to exercise. Given that the cost-effectiveness and safety of stress echocardiography are higher than those of other imaging techniques, its use is likely to be expanded further. Recent research has also proposed this technique for the evaluation of cardiac pathology beyond CAD. Although the role of new technology is promising, the assessment of cardiac function relies on good quality black and white harmonic images.

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Cardiac CT vs. Stress Testing in Patients with Suspected Coronary Artery Disease: Review and Expert Recommendations

Rahsepar

Arbab‐Zadeh

2015

Curr Cardiovasc Imaging Rep

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Diagnosis and management of coronary artery disease represent a major challenge to our health care systems affecting millions of patients each year. Until recently, the diagnosis of coronary artery disease could be conclusively determined only by invasive coronary angiography. To avoid risks from cardiac catheterization, many healthcare systems relied on stress testing as gatekeeper for coronary angiography. Advancements in cardiac computed tomography angiography technology now allows to noninvasively visualize coronary artery disease, challenging the role of stress testing as the default noninvasive imaging tool for evaluating patients with chest pain. In this review, we summarize current data on the clinical utility of cardiac computed tomography and stress testing in stable patients with suspected coronary artery disease.

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Comparison of exercise echocardiography and the Duke treadmill score for risk stratification in patients with known or suspected coronary artery disease and normal resting electrocardiogram

Cited by 24 publications

References 19 publications

Value of an Exercise Workload ≥10 Metabolic Equivalents for Predicting Inducible Myocardial Ischemia

Value of an Exercise Workload ≥10 Metabolic Equivalents for Predicting Inducible Myocardial Ischemia

Exercise echocardiography

Cardiac CT vs. Stress Testing in Patients with Suspected Coronary Artery Disease: Review and Expert Recommendations

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