Prognostic Implications of Exercise Echocardiography in Women With Known or Suspected Coronary Artery Disease

Heupler, Stephen; Mehta, Rajendra H.; Lobo, Arlene; Leung, Dominic Y.; Marwick, Thomas H.

doi:10.1016/s0735-1097(97)00167-8

Cited by 75 publications

(30 citation statements)

References 30 publications

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“…Of the latter, 851 patients were involved in 2 previous studies that used separate end points. 9,10 The clinical, exercise, and echocardiographic data of these patients were prospectively entered into separate databases, and follow-up was obtained from 1998 to 1999, after which the data were merged. Consent was obtained before testing, and the study was approved by the Institutional Review Board.…”

Section: Methodsmentioning

confidence: 99%

“…23 Previous studies with exercise echocardiography have indicated that the imaging component of this test adds incremental and independent information to the results of standard exercise testing. [7][8][9][10][11][12] A normal exercise echocardiogram is associated with a risk of Ͻ1% per year over the first 6 years of follow-up, with a subsequent small increase that most likely reflects progressive coronary artery disease.…”

Section: Assessment Of Risk In Patients With Stable Chronic Coronary mentioning

confidence: 99%

“…[7][8][9][10][11][12] Previous studies have suggested that the predictive value of a negative test is very high, although the predictive value of a positive test ranges from 17% to 35%. Echocardiographic identification of ischemia is an independent predictor of subsequent events, with these data being incremental to the prognostic information supplied by exercise testing.…”

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confidence: 99%

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Prediction of Mortality by Exercise Echocardiography

et al. 2001

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Background-In studies generally involving short follow-up, exercise echocardiography has been shown to predict composite end points. We sought to study the prediction of mortality with this test and to devise a strategy for combination with standard exercise testing. Methods and Results-Clinical, exercise testing, and echocardiographic data were collected in 5375 patients (aged 54Ϯ14 years, 3880 men) undergoing exercise echocardiography. The Duke treadmill score was derived from the results of treadmill exercise testing. Resting left ventricular (LV) function and the presence and severity of ischemia were interpreted by expert observers. Follow-up at 10.6 years (mean 5.5Ϯ1.9 years) was complete in 5211 patients (97%

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Section: Methodsmentioning

confidence: 99%

Section: Assessment Of Risk In Patients With Stable Chronic Coronary mentioning

confidence: 99%

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confidence: 99%

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Prediction of Mortality by Exercise Echocardiography

et al. 2001

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“…Women with no ECG or echocardiographic evidence of ischemia had an excellent (96%) cardiac event-free survival over Ͼ3 years of follow-up, in contrast to a much higher cardiac event rate in those women with ECG and echocardiographic findings consistent with ischemia (cardiac eventfree survival of 55%). 103 In the same study, women with positive ECG findings and negative echocardiographic findings with stress had a longer event-free survival than women with negative ECG findings but echocardiographic findings consistent with ischemia. 103 The prognostic value of exercise echocardiography appears to be similar in men and women.…”

Section: Prognostic Valuementioning

confidence: 85%

“…103 In the same study, women with positive ECG findings and negative echocardiographic findings with stress had a longer event-free survival than women with negative ECG findings but echocardiographic findings consistent with ischemia. 103 The prognostic value of exercise echocardiography appears to be similar in men and women. 55,104 Similarly, exercise SPECT provides more prognostic value than ST-segment depression alone in women.…”

Section: Prognostic Valuementioning

confidence: 85%

Exercise Stress Testing in Women

2010

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Marked reductions in cardiovascular mortality in women have occurred for the first time this decade as a result of advances in medical treatment, improvement in medical technology, and a greater focus on women and their cardiovascular risk. 1 Nonetheless, cardiovascular disease remains the No. 1 cause of death for women in the United States, and more women die from cardiovascular disease than men every year. 2 In addition, women with coronary artery disease (CAD) are more likely to have a poorer prognosis than men. 1,3,4 Women who have an acute myocardial infarction have a higher mortality than their male counterparts, and women who have symptoms of angina or an abnormal stress test are less likely to be referred for further diagnostic testing. 2,[5][6][7] Given these gender differences in the evaluation of possible CAD symptoms and the higher mortality due to CAD in women, critical steps should be taken to identify women at the earliest stage of presentation so that appropriate therapeutic strategies can be implemented. Nonetheless, identifying women with coronary disease can be a diagnostic challenge. The prevalence of CAD in younger women is low, and women tend to present with symptoms and CAD at older ages as compared with men. In addition, women may present with more atypical symptoms. 8 Women also have a lower prevalence of obstructive coronary disease, making diagnostic testing designed to detect focal areas of coronary stenosis less sensitive and specific in this population. 9 Currently, exercise stress testing is the most commonly used method of diagnosing CAD in women, 10 -12 Historically, exercise stress testing in women has been thought to have a decreased diagnostic accuracy because of a lower prevalence of CAD in women, but most early studies evaluating stress testing as a diagnostic tool were performed in almost exclusively male cohorts. [15][16][17][18][19][20][21][22][23][24][25] Until recently, the representation of women in published studies was too small to determine any gender differences in test accuracy. The underrepresentation of women, as well as the bias in selection of women when included, may be the reason for the misconceptions regarding the value of exercise stress testing in women. Nonetheless, research on exercise stress testing in women has increased in the past decade, improving our understanding of the diagnostic and prognostic value of this modality in women.The purpose of this article is to review the literature regarding exercise stress testing in women, with a focus beyond ST-segment depression alone. It addition to interpretation of ECG changes with exercise, evaluation of exercise capacity, chronotropic index, heart rate (HR) recovery (HRR), blood pressure response, and Duke Treadmill Score (DTS) can be used to enhance the utility of exercise testing. The diagnostic and prognostic value of these non-ECG variables in women is reviewed, with a goal of highlighting the importance of exercise stress testing in women on the basis of the research available to date. ST-Segment...

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Impact of contrast echocardiography on diagnostic algorithms: Pharmacoeconomic implications

Shaw

1997

Clin Cardiol

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Summary: 'Ihe major goal of medicine in the era of managed care is to control escalating costs and to attain a high level of quality health care. Capitation has limited access to expensive and unnecessary testing, placing an emphasis on the prudent use of available technology. A vast armamentarium of available diagnostic screening tests are available withii cardiology. Routine two-dimensional (2-D) echocardiography is a highquality, low-cost test that provides enhanced portability and real-time test interpretation over other noninvasive test modalities. The echocardiogram may cost up to 50% less than competitive nucleai single-photon emission computed tomography (SPG,Cr) imaging. However, on average 1096 of routine and 33% of stress echocardiograms are suboptimal (disproportionately affecting obese patients and those with lung disease). Myocardial contrast echocardiography has been shown to provide enhanced endocardial border delineation and left ventricular opacification, to enhance Doppler signal, and to provide information on myocardial perfusion. In several recent phase I1 and III studies, the use of a contrast agent has been shown to improve the diagnostic accuracy of echocardiography substantially. Improvements in the diagnostic capabilities of echocardiography have been shown to (1) impact upon downstream repetitive testing in patients with an initially nondiagnostic echocardiogram, (2) potentially incl.ease l a b oratory throughput, and (3) reduce the rate of false-positive and negative tests as a result of improved image quality. As clinical and cost-effectiveness parallel one another, the use of myocardial contrast echocardiography in selected patient co-

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Prognostic Implications of Exercise Echocardiography in Women With Known or Suspected Coronary Artery Disease

Abstract: In this large cohort of women, exercise echocardiography provided key prognostic information incremental to clinical and exercise testing data.

Cited by 75 publications

References 30 publications

Prediction of Mortality by Exercise Echocardiography

Prediction of Mortality by Exercise Echocardiography

Exercise Stress Testing in Women

Impact of contrast echocardiography on diagnostic algorithms: Pharmacoeconomic implications

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