Key result
Stress echocardiography wall-motion score index effectively stratified octogenarians into high- and low-risk groups for cardiac events (annualized event rates 5.8% vs 1.2%/year, P<0.001).
Why the study?
Does stress echocardiography provide prognostic risk stratification for nonfatal myocardial infarction and cardiac death in octogenarians?
Cohort (n=335)
Does stress echocardiography provide prognostic risk stratification for nonfatal myocardial infarction and cardiac death in octogenarians?
Absolute Event Rate: 5.8% vs 1.2%
p-value: p=<0.001
Stress echocardiography provides incremental prognostic value beyond clinical variables in octogenarians, effectively stratifying them into low- and high-risk groups for future cardiac events.
May support risk stratification in octogenarians; leaves open whether it improves outcomes or warrants routine use.
BACKGROUND: The prognostic value of stress echocardiography (SE) for the diagnosis and risk stratification of coronary artery disease in octogenarians is not well defined. METHODS: Follow-up of 5 years (mean 2.9 +/- 1.0 years) for confirmed nonfatal myocardial infarction (n = 17) and cardiac death (n = 37) was obtained in 335 patients, age > or =80 years (mean age 84 +/- 3 years, 44% male), undergoing SE (33% treadmill, 67% dobutamine). Left ventricular (LV) regional wall motion was assessed by a consensus of two echocardiographers and scored as per standard five-point scale, 16-segment model of wall motion analysis. Ischemic LV wall segment was defined as deterioration in the thickening and excursion during stress (increase in wall-motion score index (WMSI) > or =1). RESULTS: By univariate analysis, inducible ischemia (chi-square = 38.4, P < 0.001), left ventricular ejection fraction (chi-square = 41.2, P < 0.001), a history of previous myocardial infarction (chi-square = 22.3, P < 0.01), hypertension (chi-square = 33, P < 0.01), and age (chi-square = 27.7, P < 0.01) were significant predictors of future cardiac events. WMSI, an index of inducible ischemia, provided incremental prognostic information when forced into a multivariable model where clinical and rest echocardiography variables were entered first. WMSI effectively stratified octogenarians into low- and high-risk groups (annualized event rates of 1.2 versus 5.8%/year, P < 0.001). CONCLUSIONS: Stress echocardiography yields incremental prognostic information in octogenarians and effectively stratifies them into low- and high-risk groups. Precise therapeutic decision making in very elderly patients should incorporate combined clinical and stress echocardiography data.
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Chaudhry et al. (2007) conducted a cohort in Coronary artery disease (n=335). Inducible ischemia on stress echocardiography (high wall-motion score index) vs. No inducible ischemia (low wall-motion score index) was evaluated on Confirmed nonfatal myocardial infarction and cardiac death (p=<0.001). Stress echocardiography wall-motion score index effectively stratified octogenarians into high- and low-risk groups for cardiac events (annualized event rates 5.8% vs 1.2%/year, P<0.001).
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