Value of exercise echocardiography for predicting mortality in elderly patients

P>Background Elderly patients with suspected or known coronary artery disease are often referred for pharmacological stress testing. Data on the value of exercise echocardiography (ExEcho) for predicting outcome (particularly all-cause mortality) in these patients are scarce. Methods Peak treadmill ExEcho was performed in 2159 patients >= 70 years of age with known or suspected coronary artery disease. Left ventricular wall motion was evaluated at baseline and with exercise, and the increase in wall motion score index from rest to peak exercise (Delta WMSI) was calculated. Ischaemia was diagnosed when new or worsening wall motion abnormalities developed with exercise. The end points were all-cause mortality and major cardiac events (cardiac death or myocardial infarction). Results Ischaemia developed in 844 patients (38 center dot 6%) during exercise. Over a mean follow-up of 3 center dot 5 +/- 3 center dot 1 years, 439 deaths occurred. The cumulative 5-year mortality rate was 29 center dot 3% in patients with ischaemia versus 16 center dot 8% in those without ischaemia (P < 0 center dot 001). After covariate adjustment, Delta WMSI remained an independent predictor of mortality [hazard ratio (HR) 2 center dot 37, 95% confidence interval (CI) 1 center dot 66-3 center dot 39, P < 0 center dot 001] and major cardiac events (HR 3 center dot 48, 95% CI 2 center dot 11-5 center dot 74, P < 0 center dot 001). These results remained significant even in patients with chronotropic incompetence. When added to a model with clinical, resting echocardiographic and exercise electrocardiogram variables, ExEcho results provided incremental value for the prediction of both end points (P < 0 center dot 001). Conclusions ExEcho is feasible in elderly patients with suspected or known coronary artery disease and provides useful information for risk stratification in these patients.