Diagnostic Value and Prognostic Assessment of Exercise Stress Echocardiography in Patients With Suspected Coronary Artery Disease Without Typical Angina Symptoms.

Objective    To evaluate the diagnostic efficacy of exercise stress echocardiography in patients with suspected coronary artery disease (CAD) without typical angina symptoms, and to explore its predictive value for intermediate-term prognosis.Material and methods    A total of 643 patients aged 45-76 yrs (mean age 58.4±9.7 yrs) with suspected CAD but without typical angina symptoms were retrospectively enrolled in this study. All patients underwent treadmill exercise stress echocardiography using the modified Bruce protocol. Left ventricular wall motion was assessed using the 17 segment scoring method, with coronary angiography or coronary computed tomography angiography (CCTA) as the reference standard for evaluating diagnostic efficacy. The median follow-up time was 36.2 mos. The primary endpoint was a major adverse cardiovascular event (MACE) including cardiac death, non-fatal myocardial infarction, elective revascularization based on objective evidence of myocardial ischemia, and hospitalization for unstable angina. ROC curve analysis was used to evaluate diagnostic efficacy, the Kaplan-Meier method for survival analysis, and a Cox proportional hazards regression model to analyze risk factors for occurrence of MACE.Results    Of the 643 patients, 253 (39.3 %) were diagnosed with severe obstructive CAD (stenosis ≥70 %), and 246 (38.3 %) had positive results of exercise stress echocardiography. The sensitivity of exercise stress echocardiography for diagnosing severe obstructive CAD was 76.3 %, specificity was 88.5 %, AUC was 0.824, and diagnostic accuracy was 83.5 %. During follow-up, there were 89 cases (13.8 %) of MACE. The 3 yr MACE-free survival rate was 72.8 % in the positive exercise stress echocardiography group and 94.2 % in the negative group (p<0.001). Multivariate Cox regression analysis showed that positive exercise stress echocardiography immediately post-stress, wall motion score index, N-terminal pro-B-type natriuretic peptide concentration, and age were independent risk factors for MACE (all p<0.01).Conclusion    Exercise stress echocardiography demonstrated good diagnostic accuracy in patients with suspected CAD but without typical angina symptoms. It had significant predictive value for intermediate-term adverse cardiovascular events. Exercise stress echocardiography can be used for risk stratification and clinical decision-making in this population.