Cor Vasa 2018, 60(6):e615-e621 | DOI: 10.1016/j.crvasa.2018.01.006

The prognostic value of exercise stress echocardiography - Validation of a newly implemented method in our center

Luboš Jukl^a, Jiří Vondrák^a, Martin Kubrycht^a, Martin Pavolko^a,b, Petr Vojtíšek^a, Jan Matějka^a, Jan Večeřa^a,b,*

^a Kardiologické oddělení, Interní klinika, Pardubická krajská nemocnice, Nemocnice Pardubického kraje a.s., Pardubice, Česká republika

^b Kardiologické centrum Agel, a.s., Pardubice, Česká republika

Aim: The aim of this study was to assess the validity and prognostic value of exercise stress echocardiography, as a newly introduced method at our workplace, over the medium-term time horizon.

Methods and results: Between February 2014 and May 2017, 204 patients (63% males, 60 ± 11 years) underwent exercise stress echocardiography (ESE) due to stable symptoms including chest pain or exertional dyspnea, with a known or suspected ischemic heart disease (IHD). A pre-test probability of IHD was 45 ± 17%. The contrast agent was used in 25 (12%) patients. Positive test: new appearance of wall motion abnormalities in at least two adjacent left ventricular segments. The test complication rate was 0%.
ESE was positive in 13 (6%) patients, 10 of them (77%) had a significant coronary artery stenosis. ESE was non-diagnostic (patients failed to achieve 85% of maximum predicted heart rate) in 27 (13%) patients.
During the follow-up (median 17, IQR 8-29 months) 195 patients (96%) were successfully contacted. 2 (1%) patients died of malignancy, 68 (33%) were referred to coronary angiography, 2 (1%) had unstable angina pectoris (UAP), 2 (1%) had myocardial infarction (MI), 12 (6%) underwent percutaneous coronary intervention (PCI) or surgical revascularization. Patients with positive test result: n = 13 (6%): 9 (69%) underwent revascularization due to significant coronary artery stenosis, 2 (15%) had MI. Patients with non-diagnostic test n = 27 (14%): 2 (7%) died of malignancy, 1 patient underwent PCI. Patients with negative diagnostic test n = 164 (80%), 2 cases of new-onset angina pectoris within 12 months following the testing (PCI was performed).
The negative predictive value (death, MI, UAP, revascularization) of negative diagnostic test was 98.8%.

Conclusion: Exercise stress echocardiography in hands of an experienced operator is a safe and valuable method. Negative result of a diagnostic exercise stress echocardiography has, based on our experience, an excellent negative predictive value concerning cardiovascular morbidity and mortality within the 17 month-time median.

Keywords: Ischemic heart disease; Stress echocardiography

Received: December 13, 2017; Revised: January 11, 2018; Accepted: January 13, 2018; Published: December 1, 2018  Show citation