Long-term prognosis and predictors of outcomes after negative stress echocardiography
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ORIGINAL PAPER
Long‑term prognosis and predictors of outcomes after negative stress echocardiography Rayan Jo Rachwan1 · Fakilahyel S. Mshelbwala1 · Rody G. Bou Chaaya1 · Edward A. El‑Am1 · Mohammad Sabra1 · Zeina Dardari2 · Ziad A. Jaradat3 · Omar Batal3 Received: 1 May 2020 / Accepted: 4 June 2020 © Springer Nature B.V. 2020
Abstract Negative stress echocardiography (NSE) is associated with low cardiovascular morbidity and overall mortality. We aimed to determine the clinical and echocardiographic predictors of overall and cardiovascular outcomes following NSE. Patients who underwent SE between 2013 and 2017 were reviewed. Patients with a history of solid organ transplant or being evaluated for transplant, history of end-stage renal or liver disease, and positive SE were excluded. NSE results were divided into negative diagnostic if patient reached target heart rate (THR) and had no wall motion abnormality (WMA) at rest or stress; negative non-diagnostic if patient had no WMA but did not reach THR or if image quality was non-diagnostic; and abnormal non-ischemic if patient had a resting WMA not worsened at stress along with a personal history of coronary artery disease (CAD). New CAD lesion at 1 year was defined as ≥ 50% stenosis on cardiac catheterization. Of 4119 patients with SE, 2575 were included. All-cause mortality rate was 1.1%/year and CAD rate was 3.1%/year. Predictors of all-cause mortality were age, male gender, history of smoking and being selected for dobutamine SE. Predictors of a new CAD lesion at 1 year were male gender, diabetes, personal history of CAD and abnormal non-ischemic SE. We identified clinical and echocardiographic characteristics in a subset of NSE patients who are at higher risk for subsequent adverse events. These characteristics should be accounted for during the clinical interpretation of SE, and patients found at increased risk for morbidity and mortality warrant continued follow-up. Keywords Stress echocardiography · Coronary artery disease · Outcomes
Introduction Stress echocardiography (SE) is a well-validated tool for the diagnosis of coronary artery disease (CAD). The accuracy of SE in detecting significant CAD (≥ 50% coronary luminal stenosis) is reported to be 80–90% when performed by experienced operators [1]. SE has also been shown to have a prognostic role in predicting mortality, with earlier studies suggesting favorable outcomes following negative * Omar Batal [email protected] 1
Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
2
Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
3
Division of Cardiology, Department of Medicine, Indiana University School of Medicine, 1801 North Senate Boulevard, Indianapolis, IN, USA
results [2–5]. Overall mortality, as well as cardiac mortality in patients with negative SE (NSE), have been reported to be 0.1 ng/ml) and findings were confirmed by a consultant cardiologist who saw the patient at that time. Mortality was d
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