A Novel Method to Risk Stratify Patients Undergoing Exercise Stress Echocardiography Using a Set of Combined Criteria

Background and Purposes A novel method using quantitative long-axis function and tissue Doppler in addition to wall motion analysis in exercise stress echocardiography was evaluated. We hypothesized that the novel criteria added additional accuracy in stress echocardiography. Methods Patients with chest pain and at low-to-intermediate risk for obstructive coronary artery disease (CAD) were retrospectively studied. They underwent stress echocardiography with attention to wall motion abnormalities, left ventricular long-axis function, and tissue Doppler measurement. Results The results showed that the combined novel criteria (i.e., classifying a case as positive if three out of the following four criteria were fulfilled: (1) abnormal segmental wall motion shortly after peak stress; (2) Ee wave after peak stress less than 10 cm/s and Ee/Aa ratio after peak stress less than 1; (3) Sm wave after peak stress less than 10.5 cm/s; (4) abnormal long-axis left ventricular function) offered a better accuracy for predicting obstructive CAD and future revascularization with a high sensitivity (100%) and high negative predictive value (100%) . Conclusion From a practical standpoint, the combined novel criteria may be useful in improving the diagnostic accuracy of stress echocardiography.