Yao S-S et al. (2004) Novel stress echocardiographic model incorporating the extent and severity of wall motion abnormality for risk stratification and prognosis. Am J Cardiol 94: 715–719

Stress echocardiography is commonly used for the diagnosis of coronary artery disease (CAD), but its prognostic value is poorly defined. Yao et al. have devised a prognostic model based on the extent and severity of wall-motion abnormalities as measured by this method.

A cohort of 1,500 patients with known or suspected CAD were included in the analysis. All patients were assessed by stress echocardiography with exercise-induced (34%) or dobutamine-induced (66%) stress. The echocardiograms–obtained at baseline, at each stage of stress and during recovery–were interpreted by consensus of two echocardiographers. Briefly, the image of the left ventricle was divided into 16 segments, each of which was scored as (1) normal, (2) mild to moderate hypokinesia, (3) severe hypokinesia, (4) akinesia or (5) dyskinesia.

During a mean follow-up of 2.7 ± 1.0 years, nonfatal myocardial infarction occurred in 31 (2.1%) patients and cardiac death was recorded in a further 44 (2.9%). Multivariate analysis showed that two echocardiographic measures were independent predictors of cardiac events. These were the number of segments with new wall-motion abnormalities (the 'ischemic extent') and the maximal magnitude of the abnormalities (the 'maximal severity') at peak stress. The predicted event rate for patients with extensive and severe wall-motion abnormalities was approximately seven-fold higher than for those with no such abnormalities.

This new model presents a noninvasive approach to risk stratification and prognosis in patients with suspected or known ischemic heart disease.