Prognostic value of stress echocardiography in the evaluation of atypical chest pain patients without known coronary artery disease

P. J. Colon, S. K. Mobarek, R. V. Milani, C. J. Lavie, M. M. Cassidy, J. P. Murgo, J. Cheirif

Research output: Contribution to journalArticlepeer-review

37 Scopus citations

Abstract

Patients with atypical chest pain frequently lack significant coronary artery disease (CAD) and are, therefore, at low risk for future adverse cardiovascular events. We hypothesized that in this group of patients, stress echocardiography could identify those at risk for cardiac events. We retrospectively reviewed (mean follow-up 23.0 ± 7.2 months) the prognostic value of stress echocardiography for major (cardiac death, myocardial infarction, congestive heart failure, and unstable angina) and total (major events plus coronary revascularization) cardiac events in 661 patients with atypical chest pain, normal global left ventricular (LV) systolic function, and no history of CAD. A positive stress echocardiogram was defined as the development of new or worsening wall motion abnormalities with exercise stress (80%) or dobutamine (20%). A total of 41 cardiac and 16 major events were noted. The event-free survival for total cardiac events was 97% for a normal stress echocardiogram (ECG) at 30 months. A positive stress ECG predicted on event-free rate of 86% compared with 74% for stress-induced LV dysfunction accompanied the wall motion abnormalities. A strategy recommending invasive studies based on positive stress echocardiogram results increased the per-patient cost, but led to greater savings per cardiac event predicted and provided incremental prognostic value for future cardiac events beyond clinical and stress electrocardiographic data. Thus, stress echocardiography in low-risk patients for CAD appears to be more cost effective than a stress ECG.

Original languageEnglish (US)
Pages (from-to)545-551
Number of pages7
JournalAmerican Journal of Cardiology
Volume81
Issue number5
DOIs
StatePublished - Mar 1 1998
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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