Positive exercise stress echocardiography predicted lower 3-year MACE-free survival compared to negative results in suspected CAD without typical angina (72.8% vs 94.2%, p<0.001).
Cohort (n=643)
Does exercise stress echocardiography accurately diagnose severe obstructive CAD and predict MACE in patients with suspected CAD without typical angina symptoms?
Exercise stress echocardiography provides good diagnostic accuracy and significant prognostic value for intermediate-term MACE in patients with suspected CAD who lack typical angina symptoms.
Absolute Event Rate: 72.8% vs 94.2%
p-value: p=<0.001
Objective To evaluate the diagnostic efficacy of exercise stress echocardiography in patients with suspected coronary artery disease (CAD) without typical angina symptoms, and to explore its predictive value for intermediate-term prognosis.Material and methods A total of 643 patients aged 45-76 yrs (mean age 58.4±9.7 yrs) with suspected CAD but without typical angina symptoms were retrospectively enrolled in this study. All patients underwent treadmill exercise stress echocardiography using the modified Bruce protocol. Left ventricular wall motion was assessed using the 17 segment scoring method, with coronary angiography or coronary computed tomography angiography (CCTA) as the reference standard for evaluating diagnostic efficacy. The median follow-up time was 36.2 mos. The primary endpoint was a major adverse cardiovascular event (MACE) including cardiac death, non-fatal myocardial infarction, elective revascularization based on objective evidence of myocardial ischemia, and hospitalization for unstable angina. ROC curve analysis was used to evaluate diagnostic efficacy, the Kaplan-Meier method for survival analysis, and a Cox proportional hazards regression model to analyze risk factors for occurrence of MACE.Results Of the 643 patients, 253 (39.3 %) were diagnosed with severe obstructive CAD (stenosis ≥70 %), and 246 (38.3 %) had positive results of exercise stress echocardiography. The sensitivity of exercise stress echocardiography for diagnosing severe obstructive CAD was 76.3 %, specificity was 88.5 %, AUC was 0.824, and diagnostic accuracy was 83.5 %. During follow-up, there were 89 cases (13.8 %) of MACE. The 3 yr MACE-free survival rate was 72.8 % in the positive exercise stress echocardiography group and 94.2 % in the negative group (p<0.001). Multivariate Cox regression analysis showed that positive exercise stress echocardiography immediately post-stress, wall motion score index, N-terminal pro-B-type natriuretic peptide concentration, and age were independent risk factors for MACE (all p<0.01).Conclusion Exercise stress echocardiography demonstrated good diagnostic accuracy in patients with suspected CAD but without typical angina symptoms. It had significant predictive value for intermediate-term adverse cardiovascular events. Exercise stress echocardiography can be used for risk stratification and clinical decision-making in this population.
Zhu et al. (Thu,) conducted a cohort in Suspected coronary artery disease without typical angina symptoms (n=643). Positive exercise stress echocardiography vs. Negative exercise stress echocardiography was evaluated on Major adverse cardiovascular event (MACE) including cardiac death, non-fatal myocardial infarction, elective revascularization based on objective evidence of myocardial ischemia, and hospitalization for unstable angina (p=<0.001). Positive exercise stress echocardiography predicted lower 3-year MACE-free survival compared to negative results in suspected CAD without typical angina (72.8% vs 94.2%, p<0.001).