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Exercise echocardiography in patients with suspected or known coronary artery disease – Is there still a role for electrocardiographic changes?
Session:
Posters - E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Speaker:
Mário Rui Lourenço
Congress:
CPC 2021
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
12. Coronary Artery Disease (Chronic)
Subtheme:
12.3 Coronary Artery Disease – Diagnostic Methods
Session Type:
Posters
FP Number:
---
Authors:
Mário Lourenço; Ana Filipa Cardoso; Filipa Castro; Pedro Von Hafe; Tamara Pereira; Marina Fernandes; Olga Azevedo; Isabel Nogueira; António Lourenço
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Background: </span></strong><span style="color:black">Exercise echocardiography (EE) is a useful method for diagnosis and risk stratification in patients (pts) with suspected or known coronary artery disease (CAD). There has been a growing scientific consensus that imaging stress tests should be preferred over ECG stress tests in these pts whenever available. Our aim was to assess if the presence of electrocardiographic changes has any role on predicting outcomes when there are no changes in ventricular wall motion in EE.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Methods: </span></strong><span style="color:black">Single-center retrospective study of consecutive patients with suspected or known CAD who performed an EE between 2018 and 2019 and had a negative result for myocardial ischemia. Clinical, electrocardiographic and echocardiographic data were collected. The primary endpoint was a composite of admission for acute coronary syndrome (ACS), coronary revascularization and cardiovascular death during the follow-up.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Results: </span></strong><span style="color:black">A total of 79 pts were included (mean age 59±9 years; 67% male). The two main indications for performing EE in these patients were new onset chest pain (33 pts; 42%) and previous positive ECG stress test (26 pts; 33%). </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">20 pts (26%) had electrocardiographic changes suggestive of ischemia during exercise, despite having no alterations in ventricular wall contractility. There were no differences in exercise time (9.6±2.9 vs 9±1.9 minutes, P=.429), nor in mean METS achieved (10,6±2.4 vs 10.2±1,6, P=.446) between these two groups.</span></span></span><br /> <span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">During a median follow up of 22 months (IQR 15-28), the primary endpoint did not occur in any patient, regardless of electrocardiographic</span><span style="color:black"> changes during exercise.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Conclusion:</span></strong><span style="color:black"> The prognosis of patients with negative EE was excellent, as these patients did not suffer cardiovascular events in the follow-up. The occurrence of electrocardiographic changes suggestive of ischemia during EE were not relevant to further stratify the risk of coronary events in these patients. These findings reinforce that EE has a higher prognostic value than ECG stress test in patients with suspected or known CAD.</span></span></span></p>
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