Abnormal exercise echocardiography plus abnormal E/e' ratio at exercise portends worse outcome in patients with dyspnea.
E/e′ values
Exercise echocardiography
Ischemia
Journal
Journal of cardiology
ISSN: 1876-4738
Titre abrégé: J Cardiol
Pays: Netherlands
ID NLM: 8804703
Informations de publication
Date de publication:
01 2019
01 2019
Historique:
received:
11
05
2018
revised:
03
07
2018
accepted:
17
07
2018
pubmed:
9
9
2018
medline:
31
1
2020
entrez:
9
9
2018
Statut:
ppublish
Résumé
The role of exercise echocardiography (ExE) for the assessment of patients with dyspnea is promising. We aimed to analyze the clinical characteristics and outcome of patients with this condition referred for ExE. A total of 505 patients (66 ± 11 years, 57% women) referred for evaluation of dyspnea were considered. Mitral regurgitation, ratio of early left ventricular inflow wave to early diastolic annulus wave (E/e'), and wall motion abnormalities (WMAs) were measured at rest and at exercise. Considered events were overall mortality, non-fatal myocardial infarction, late revascularization, and admission for heart failure. Ischemia was observed in 102 patients (20%), whereas WMAs were already present at rest in 55 patients (11%). A percent achieved of predicted metabolic equivalents >100% was found for most of the patients (70%). During a median follow-up of 3.50 years, 66 patients had events (annualized event rate 3.5%). An E/e' value of 13 at post-exercise was the best cut-off value to predict events. After adjustment by clinical and ExE variables, the combination of an abnormal ExE and E/e' values at post-exercise ≥13 was an independent predictor of events (hazard ratio = 3.67, 95% confidence interval = 2.11-6.38, p < 0.001). The worse outcome corresponded to patients with abnormal ExE and raised E/e' values at post-exercise (annualized event rate 17.2%). Patients with normal E/e' values at post-exercise had better outcome irrespective of the ExE results (annualized event rate 2.2% with normal ExE and 2.9% with abnormal ExE), whereas patients with high E/e' values at post-exercise but normal ExE results were at intermediate risk (annualized event rate 5.0%). Despite favorable ExE results, event rate remains high among patients with dyspnea referred for ExE, which may have a role to predict outcome in this setting. Patients with both raised E/e' values at post-exercise and abnormal ExE results are at the highest event risk.
Sections du résumé
BACKGROUND
The role of exercise echocardiography (ExE) for the assessment of patients with dyspnea is promising. We aimed to analyze the clinical characteristics and outcome of patients with this condition referred for ExE.
METHODS
A total of 505 patients (66 ± 11 years, 57% women) referred for evaluation of dyspnea were considered. Mitral regurgitation, ratio of early left ventricular inflow wave to early diastolic annulus wave (E/e'), and wall motion abnormalities (WMAs) were measured at rest and at exercise. Considered events were overall mortality, non-fatal myocardial infarction, late revascularization, and admission for heart failure.
RESULTS
Ischemia was observed in 102 patients (20%), whereas WMAs were already present at rest in 55 patients (11%). A percent achieved of predicted metabolic equivalents >100% was found for most of the patients (70%). During a median follow-up of 3.50 years, 66 patients had events (annualized event rate 3.5%). An E/e' value of 13 at post-exercise was the best cut-off value to predict events. After adjustment by clinical and ExE variables, the combination of an abnormal ExE and E/e' values at post-exercise ≥13 was an independent predictor of events (hazard ratio = 3.67, 95% confidence interval = 2.11-6.38, p < 0.001). The worse outcome corresponded to patients with abnormal ExE and raised E/e' values at post-exercise (annualized event rate 17.2%). Patients with normal E/e' values at post-exercise had better outcome irrespective of the ExE results (annualized event rate 2.2% with normal ExE and 2.9% with abnormal ExE), whereas patients with high E/e' values at post-exercise but normal ExE results were at intermediate risk (annualized event rate 5.0%).
CONCLUSIONS
Despite favorable ExE results, event rate remains high among patients with dyspnea referred for ExE, which may have a role to predict outcome in this setting. Patients with both raised E/e' values at post-exercise and abnormal ExE results are at the highest event risk.
Identifiants
pubmed: 30193806
pii: S0914-5087(18)30230-2
doi: 10.1016/j.jjcc.2018.07.003
pii:
doi:
Types de publication
Evaluation Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
73-80Informations de copyright
Copyright © 2018 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.