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Submitted: 30 Apr 2019
Accepted: 17 May 2019
First published online: 13 Jun 2019
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J Cardiovasc Thorac Res. 2019;11(2):85-94.
doi: 10.15171/jcvtr.2019.16
PMID: 31384401
PMCID: PMC6669423
  Abstract View: 115
  PDF Download: 116

Original Article

The value of negative stress echocardiography in predicting cardiovascular events among adults with no known coronary disease

Niloufar Samiei 1, Mozhgan Parsaee 2, Leili Pourafkari 2,3 * , Arezou Tajlil 2, Yeganeh Pasbani 1, Ali Rafati 1, Nader D Nader 3

1 Heart Valve Research Center, Rajaie Cardiovascular Medical & Research Center, Tehran, Iran
2 Echocardiography Research Center, Rajaie Cardiovascular Medical & Research Center, Tehran, Iran
3 Department of Anesthesiology, State University of New York at Buffalo, Buffalo, NY, USA


Introduction: Stress echocardiography is a safe and cost-effective method of evaluating the patients with suspected coronary artery disease (CAD). However, the risk factors of an adverse cardiovascular event after a normal exercise (ESE) or dobutamine (DSE) stress echocardiography are not well established.
Methods: A cohort of 705 patients without previous history of CAD and a negative ESE/DSE was studied. All studies were performed in a high-volume echocardiologic laboratory and interpreted by two experienced echocardiography-trained cardiologists. Patients with inconclusive studies and those with an evidence of myocardial ischemia were excluded. Demographic, echocardiographic and hemodynamic findings were recorded. Patients were followed for at least 2 years. Independent predictors of major adverse cardiovascular events (MACE) were determined by regression analysis.
Results: During a period of 55.7±17.5 months, MACE occurred in 35 (5.0%) of patients. Negative predictive value (NPV) of DSE was 89.2%, which was significantly less than 96.5% for ESE in predicting the occurrence of MACE (P = 0.001). MACE occurred more frequently among older (≥65 years) men with preexisting diabetes, hypertension, and/or hyperlipidemia. During ESE, a higher maximum blood pressure*heart rate product for the achieved level of metabolic equivalent (METS) of tasks was also an independent predictor of MACE.
Conclusion: Inability of patients to undergo traditional ESE that led to the choice of using DSE alternative reduces the NPV of the stress echocardiography among patients without previous history of CAD. A modest rise of heart rate and blood pressure in response to increased level of activity serves as favorable prognostic value and improves the NPV of stress echocardiography.
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