Evaluation of the Diagnostic Value and Prognostic Role of Positive Exercise Stress Echocardiography in Coronary Artery Disease

Document Type : Original Article

Authors

1 Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

2 Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

3 Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, IR Iran.

Abstract

Background: Despite steps in lifestyle changes and preventive measures, the incidence of heart disease is still rising. Coronary artery disease (CAD) is the world’s leading cause of death; thus, the early detection of this disease can significantly reduce its mortality rate. We evaluated the diagnostic value and prognostic role of positive exercise stress echocardiography in CAD.
Methods: The present retrospective study was performed on 350 patients with symptoms of IHD referred for exercise stress echocardiography between 2004 and 2017. The obtained data were analyzed using the SPSS software.
Results: Ischemic electrocardiographic (ECG) changes, the regional wall motion abnormality (RWMA) score index, the metabolic equivalent, and the peak left ventricular ejection fraction were associated with CAD (P=0.004, P=0.000, P=0.02, and P=0.000, respectively). The incidence of ventricular arrhythmias was associated with sudden cardiac death and myocardial infarction (P=0.00). Ischemic ECG changes were significantly associated with myocardial infarction and the need for percutaneous coronary interventions in the future (P=0.04 and P=0.03). The relationship between left ventricular dilation and sudden cardiac death was significant (P=0.01), and RWMAs were significantly associated with myocardial infarction (P=0.03). However, dyspnea and chest pain had no association with cardiac events.
Conclusions: Positive exercise stress echocardiography was associated with sudden cardiac death, myocardial infarction, and the need for future coronary revascularization, and its diagnostic and predictive role was observed in ischemic heart disease and predicting future cardiac events. (Iranian Heart Journal 2023; 24(2): 69-76)

Keywords


  1. Olvera Lopez E, Ballard BD, Jan A. Cardiovascular Disease. Treasure Island (FL): StatPearls Publishing Copyright © 2021, StatPearls Publishing LLC.; 2021.
  2. Carvalho-Pinto BP, Faria CD. Health, function and disability in stroke patients in the community. Braz J Phys Ther 2016;20:355-66. doi: 10.1590/bjpt-rbf.2014.0171.
  3. Robson J, Ayerbe L, Mathur R, Addo J, Wragg A. Clinical value of chest pain presentation and prodromes on the assessment of cardiovascular disease: a cohort study. BMJ Open 2015;5:e007251. doi: 10.1136/bmjopen-2014-007251.
  4. Picano E. Stress echocardiography: Springer sixth edition; 2015.
  5. Senior R, Monaghan M, Becher H, Mayet J, Nihoyannopoulos P. Stress echocardiography for the diagnosis and risk stratification of patients with suspected or known coronary artery disease: a critical appraisal. Supported by the British Society of Echocardiography. Heart 2005; 91:427-36. doi: 10.1136/hrt.2004.044396.
  6. Picano E. Dipyridamole-echocardiography test: historical background and physiologic basis. Eur Heart J 1989;10:365-76. doi: 10.1093/oxfordjournals.eurheartj.a059494.
  7. Gallagher KP, Matsuzaki M, Koziol JA, Kemper WS, Ross J, Jr. Regional myocardial perfusion and wall thickening during ischemia in conscious dogs. Am J Physiol 1984;247:H727-38. doi: 10.1152/ajpheart.1984.247.5.H727.
  8. Lancellotti P, Pellikka PA, Budts W, Chaudhry FA, Donal E, Dulgheru R, et al. The clinical use of stress echocardiography in non-ischaemic heart disease: recommendations from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2016;17:1191-229. doi: 10.1093/ehjci/jew190.
  9. Kusunose K, Yamada H, Hotchi J, Bando M, Nishio S, Hirata Y, et al. Prediction of Future Overt Pulmonary Hypertension by 6-Min Walk Stress Echocardiography in Patients With Connective Tissue Disease. J Am Coll Cardiol 2015;66:376-84. doi: 10.1016/j.jacc.2015.05.032.
  10. Picano E, Ciampi Q, Citro R, D'Andrea A, Scali MC, Cortigiani L, et al. Stress echo 2020: the international stress echo study in ischemic and non-ischemic heart disease. Cardiovasc Ultrasound 2017;15:3. doi: 10.1186/s12947-016-0092-1.
  11. Merchan Ortega G, Bonaque Gonzalez JC, Sanchez Espino AD, Aguado Martin MJ, Navarro Garcia F, Ruiz Lopez F, et al. Long-term prognostic value of peak exercise echocardiogram in patients hospitalized with acute chest pain. Echocardiography 2017;34:869-75. doi: 10.1111/echo.13530.
  12. Yao SS, Wever-Pinzon O, Zhang X, Bangalore S, Chaudhry FA. Prognostic value of stress echocardiogram in patients with angiographically significant coronary artery disease. Am J Cardiol 2012;109:153-8. doi: 10.1016/j.amjcard.2011.08.023.
  13. Ludka O, Trna J, Galkova L, Musil V, Spinar J. Usefulness of exercise tissue doppler echocardiography for prognostic stratification of congestive heart failure patients with left ventricular systolic dysfunction. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2013; 157:27-34. doi: 10.5507/bp.2012.014.
  14. Bouzas-Mosquera A, Peteiro J, Alvarez-García N, Broullón FJ, García-Bueno L, Ferro L, et al. Prognostic value of exercise echocardiography in patients with left bundle branch block. JACC Cardiovasc Imaging 2009;2:251-9. doi: 10.1016/j.jcmg.2008.11.014.
  15. Hwang JW, Park SJ, Kim EK, Chang SA, Choi JO, Lee SC, et al. Clinical implications of exercise-induced regional wall motion abnormalities in significant aortic regurgitation. Echocardiography 2020;37:1583-93. doi: 10.1111/echo.14855.
  16. Innocenti F, Cerabona P, Donnini C, Conti A, Zanobetti M, Pini R. Long-term prognostic value of stress echocardiography in patients presenting to the ED with spontaneous chest pain. Am J Emerg Med 2014;32:731-6. doi: 10.1016/j.ajem.2014.03.026.
  17. Peteiro J, Bouzas-Mosquera A, Broullón F, Martinez D, Yañez J, Castro-Beiras A. Value of an exercise workload ≥10 metabolic equivalents for predicting inducible myocardial ischemia. Circ Cardiovasc Imaging 2013;6:899-907. doi: 10.1161/circimaging.113.000413.
  18. Peteiro J, Bendayan I, Mariñas J, Campos R, Bouzas B, Castro-Beiras A. Prognostic value of mitral regurgitation assessment during exercise echocardiography in patients with left ventricular dysfunction: a follow-up study of 1.7 +/- 1.5 years. Eur J Echocardiogr 2008;9:18-25. doi: 10.1016/j.euje.2006.11.013.
  19. Anand V, Kane GC, Scott CG, Pislaru SV, Adigun RO, McCully RB, et al. Prognostic value of peak stress cardiac power in patients with normal ejection fraction undergoing exercise stress echocardiography. Eur Heart J 2021;42:776-85. doi: 10.1093/eurheartj/ehaa941.
  20. Marques A, Cruz I, João I, Almeida AR, Fazendas P, Caldeira D, et al. The Prognostic Value of Exercise Echocardiography After Percutaneous Coronary Intervention. J Am Soc Echocardiogr 2021;34:51-61. doi: 10.1016/j.echo.2020.09.001.