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There are limitations to Framingham Risk Score (FRS) in risk assessment. The purpose of this study was to evaluate the role of stress echocardiography (SEcho) in risk stratification across all FRS groups.
We evaluated 4566 patients (60 ± 13 years; 46% male) divided into: Low (<10%, n = 3391), Intermediate (10-20%, n = 700) and High (>20%, n = 3391) FRS who underwent SEcho. Resting left ventricular ejection fraction and regional wall motion were assessed. The left ventricle was divided into 16 segments and scored on a 5-point scale of wall motion. Abnormal SEcho was defined as stress-induced ischemia (wall-motion score of ≥1 grade). Follow-up (3.3 ± 1.5 years) for non-fatal myocardial infarction (n = 95) and cardiac death (n = 147) were obtained.
By univariate analysis, diabetes (p <0.001), ejection fraction (p <0.001) and new ischemic wall motion abnormalities (p <0.001) were significant predictors of cardiac events. Cumulative survival was significantly worse in all FRS groups with abnormal vs. normal SEcho: low (1.1%/ year vs. 0.1%/year, p = 0.04), intermediate (3.3%/year vs. 0.5%/year, p <0.0001) and high (3.4%/year vs. 0.9%/year, p <0.0001). Multivariate Cox proportional hazards analysis identified new ischemic wall motion abnormalities as the strongest predictor of cardiac events (HR 2.4, 95% CI 1.7-3.3, p <0.001).
SEcho can effectively risk stratify across spectrum of all FRS groups. Normal Secho portends a benign prognosis in all FRS groups.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Imaging: Echocardiographic Imaging of Patients with CAD: I
Abstract Category: 18. Imaging: Echo
Presentation Number: 1267-323
- 2013 American College of Cardiology Foundation