Key result
Increased or unchanged exercise LV end-systolic size predicts ~61% greater risk of cardiac death or MI.
Why the study?
The exercise capacity of patients with known or suspected CAD is prognostic, but the implications of the extent and severity of exercise echocardiographic abnormalities in patients with good exercise capacity remained to be defined.
Does the extent and severity of exercise-related LV dysfunction on echocardiography predict cardiac death or nonfatal MI in patients with known or suspected CAD and good exercise capacity?
Cohort (n=1,874)
Does the extent and severity of exercise-related LV dysfunction on echocardiography predict cardiac death or nonfatal MI in patients with known or suspected CAD and good exercise capacity?
In patients with good exercise capacity, echocardiographic descriptors of exercise-related LV dysfunction provide independent and incremental prognostic value for predicting cardiac death or nonfatal MI.
OBJECTIVES We sought to define the prognostic implications of the extent and severity of exercise echocardiographic abnormalities in patients with good exercise capacity. BACKGROUND; The exercise capacity of patients with known or suspected coronary artery disease (CAD) is of prognostic importance, as is the extent of exercise-related left ventricular (LV) hypoperfusion or dysfunction. METHODS We examined the outcomes of 1,874 patients with known or suspected CAD (mean age 64 +/- 10 years, 64% men) who had good exercise capacity (> or = 5 metabolic equivalents [METs] for women, > or = 7 METs for men) but abnormal exercise echocardiograms and analyzed the potential association between clinical, exercise and echocardiographic variables and subsequent cardiac events. RESULTS Multivariate predictors of time to cardiac death or nonfatal myocardial infarction (MI) were diabetes mellitus (risk ratio [RR] 1.88; 95% confidence interval [CI] 1.2 to 3.0), history of MI (RR 2.44; 95% CI 1.6 to 3.6) and an increase or no change in LV end-systolic size in response to exercise (RR 1.61; 95% CI 1.1 to 2.5). Using echocardiographic variables that were of incremental prognostic value, we were able to stratify the cardiac risk of the study population; cardiac death or nonfatal MI rate per person-year of follow-up was 1.6% for patients who had a decrease in LV end-systolic size in response to exercise (n = 1,330) and 1.2% for patients who did not have any severely abnormal LV segments immediately after exercise (n = 868). CONCLUSIONS In patients with good exercise capacity, echocardiographic descriptors of the extent and severity of exercise-related LV dysfunction were of independent and incremental prognostic value. Stratification of patients into low- and higher risk subgroups was possible using these exercise echocardiographic characteristics.
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McCully et al. (2002) conducted a cohort in Known or suspected coronary artery disease (n=1,874). Increase or no change in left ventricular end-systolic size in response to exercise vs. Decrease in left ventricular end-systolic size in response to exercise was evaluated on Time to cardiac death or nonfatal myocardial infarction (RR 1.61, 95% CI 1.1 to 2.5). An increase or no change in left ventricular end-systolic size during exercise was a significant predictor of cardiac death or nonfatal MI (RR 1.61; 95% CI 1.1-2.5).
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