Inconclusive stress echocardiography tests, mainly due to failure to reach submaximal heart rate, are linked to significantly lower survival, similar to positive test results.
Does an inconclusive stress echocardiography test result predict all-cause mortality compared to positive or negative results in patients undergoing stress testing?
Inconclusive stress echocardiography tests, most commonly due to failure to reach submaximal heart rate, carry a poor prognosis for survival similar to that of positive ischemic tests.
Tasa de eventos absoluta: 0% vs 0%
Abstract Background Inconclusive results from stress echocardiography tests are often excluded from data analysis. However, they can also provide valuable information. Aim To assess the most common causes of inconclusive stress echocardiography tests and compare all-cause mortality of inconclusive, positive, and negative test results over a 20-year period. Methods 28,239 results of dobutamine and exercise stress tests were retrieved from the stress echocardiography database in one tertial center since January 2002 to June 2022. Data was collected prospectively during patient visits, including demographics, the reason for the referral, the test termination, ultrasound, ECG changes, symptoms at rest and stress. Repeated tests of the same patient, referrals for cardiac obstruction, valvular pathology, and tests with poor ultrasound image quality have been excluded. The upper limit of follow-up was set at 7.4 years (2700 days), which reflects the average survival in the dataset. Results The final population comprised of 21,061 patients. The stress test results were normal in 16,612 patients (78.9%), ischemia was detected in 4,038 patients (19.2%), and 411 tests (1.9%) remained inconclusive. The most common reasons for inconclusive tests were not achieved submaximal heart rate (31%, 128), uncertain (11%, 47); ventricular rhythm disorders (10%, 43); abnormal blood pressure (10%, 40), intolerable symptoms (8%, 32); not performed (8%, 31); bradycardia (7%, 27); chest pain (5%, 22); disorders of rhythm and conduction (4%, 15); other (2%, 10); weak left ventricular (2%, 7); dyspnoea 1% (5); leg fatigue (1%, 4) (Figure 1). The data indicated that inconclusive tests are associated with significantly lower survival similar to positive tests (Figure 2). Conclusion The most common reason for an inconclusive test is a failure to reach the submaximal heart rate, potentially related to impaired chronotropic response and to increased mortality. Our analysis confirms that the prognosis of inconclusive tests is poor, comparable to that of positive tests, if not even worse.Figure 1. Figure 2.
Balkevičienė et al. (Sat,) reported a other. Inconclusive stress echocardiography tests, mainly due to failure to reach submaximal heart rate, are linked to significantly lower survival, similar to positive test results.