the value of negative stress echocardiography in predicting cardiovascular events among adults with no known coronary disease

Introduction: stress echocardiography is a safe and cost-effective method of evaluating the patients with suspected coronary artery disease (cad). however, the risk factors of an adverse cardiovascular event after a normal exercise (ese) or dobutamine (dse) stress echocardiography are not well established. methods: a cohort of 705 patients without previous history of cad and a negative ese/dse was studied. all studies were performed in a high-volume echocardiologic laboratory and interpreted by two experienced chocardiography-trained cardiologists. patients with inconclusive studies and those with an evidence of myocardial ischemia were excluded. demographic, echocardiographic and hemodynamic findings were recorded. patients were followed for at least 2 years. independent predictors of major adverse cardiovascular events (mace) were determined by regression analysis. results: during a period of 55.7±17.5 months, mace occurred in 35 (5.0%) of patients. negative predictive value (npv) of dse was 89.2%, which was significantly less than 96.5% for ese in predicting the occurrence of mace (p = 0.001). mace occurred more frequently among older (≥65 years) men with preexisting diabetes, hypertension, and/or hyperlipidemia. during ese, a higher maximum blood pressure*heart rate product for the achieved level of metabolic equivalent (mets) of tasks was also an independent predictor of mace. conclusion: inability of patients to undergo traditional ese that led to the choice of using dse alternative reduces the npv of the stress echocardiography among patients without previous history of cad. a modest rise of heart rate and blood pressure in response to increased level of activity serves as favorable prognostic value and improves the npv of stress echocardiography.