Prognostic significance of exercise stress echocardiography in 3329 outpatients (5-year longitudinal study)

Background Appraisal of the risk to which outpatients with chest pain are exposed is a major clinical problem. Up to now, there have been no reports on the prognostic significance of exercise stress echocardiography in this patient cohort. Patients and methods In order to investigate the prognostic significance of exercise stress echocardiography (SE) in outpatients only, 3329 patients were monitored during a long-term follow-up regarding the occurrence of hard events (cardiac death, myocardial infarction, revascularization). The patients came to the cardiology practice complaining of chest pain. Results The sensitivity/specificity of SE for hard events was 81.1/92.8 in the first year, that of exercise ECG, 27.4/87.0. During the observation period (5.1 ± 1.1 years (median 5.2, 3–7 years)), a total of 446 (13.4%) hard events occurred. In patients with positive SE findings, 262 (61.9%) hard events occurred, in patients with negative SE findings, hard events were rarer (184, 6.3%, p < 0.001). In the multivariate analysis, the positive SE finding was the most unambiguous, significant independent predictor of hard events (HR 6.6, CI 5.21–8.25, p < 0.001). Conclusions In outpatients with chest pains, exercise stress echocardiography is of major prognostic significance (independent of other parameters) and its prognostic reliability is clearly superior to that of the exercise ECG. SE should always be performed in cases with symptoms requiring clarification.