OBJECTIVES: The purpose of this study was to characterize the outcome of patients referred for exercise echocardiographic evaluation of dyspnea. BACKGROUND: Little information exists regarding outcome of patients with dyspnea. METHODS: We identified 443 patients with unexplained dyspnea, 2,033 with chest pain, and 587 with both symptoms referred for exercise echocardiography. RESULTS: Compared to those with chest pain alone, patients referred for dyspnea alone were older, predominantly men, and had lower workload, lower ejection fraction (EF), more prior myocardial infarction (MI), and abnormal rest electrocardiograms. Patients with both symptoms were similar to those with dyspnea, but more had prior revascularization. Exercise echocardiography showed ischemia in 42% of patients with dyspnea, 19% with chest pain, and 58% with both symptoms. During 3.1 +/- 1.8 years follow-up, cardiac death (5.2% vs. 0.9%, p < 0.0001) and nonfatal MI (4.7% vs. 2.0%, p < 0.0001) occurred more often in patients with dyspnea. Events in patients with both symptoms were similar to those with dyspnea, except for revascularization (20% vs. 13%, p = 0.0004). For patients with dyspnea, independent predictors of events were previous MI (hazard ratio [HR] 3.35, p < 0.0001), male gender (HR 1.94, p = 0.0252), EF (HR 0.95/10% increment, p < 0.0001), and increase in wall motion score index with exercise (HR 4.19/0.25 U, p < 0.0001), but not chest pain. CONCLUSIONS: Patients with unexplained dyspnea have a high likelihood of ischemia and an increased incidence of cardiac events. Exercise echocardiography provides independent information for identifying patients at risk. In patients with known or suspected coronary artery disease, dyspnea is a symptom requiring investigation.
OBJECTIVES: The purpose of this study was to characterize the outcome of patients referred for exercise echocardiographic evaluation of dyspnea. BACKGROUND: Little information exists regarding outcome of patients with dyspnea. METHODS: We identified 443 patients with unexplained dyspnea, 2,033 with chest pain, and 587 with both symptoms referred for exercise echocardiography. RESULTS: Compared to those with chest pain alone, patients referred for dyspnea alone were older, predominantly men, and had lower workload, lower ejection fraction (EF), more prior myocardial infarction (MI), and abnormal rest electrocardiograms. Patients with both symptoms were similar to those with dyspnea, but more had prior revascularization. Exercise echocardiography showed ischemia in 42% of patients with dyspnea, 19% with chest pain, and 58% with both symptoms. During 3.1 +/- 1.8 years follow-up, cardiac death (5.2% vs. 0.9%, p < 0.0001) and nonfatal MI (4.7% vs. 2.0%, p < 0.0001) occurred more often in patients with dyspnea. Events in patients with both symptoms were similar to those with dyspnea, except for revascularization (20% vs. 13%, p = 0.0004). For patients with dyspnea, independent predictors of events were previous MI (hazard ratio [HR] 3.35, p < 0.0001), male gender (HR 1.94, p = 0.0252), EF (HR 0.95/10% increment, p < 0.0001), and increase in wall motion score index with exercise (HR 4.19/0.25 U, p < 0.0001), but not chest pain. CONCLUSIONS:Patients with unexplained dyspnea have a high likelihood of ischemia and an increased incidence of cardiac events. Exercise echocardiography provides independent information for identifying patients at risk. In patients with known or suspected coronary artery disease, dyspnea is a symptom requiring investigation.
Authors: Mohammed Qintar; J Aaron Grantham; James Sapontis; Kensey L Gosch; William Lombardi; Dimitri Karmpaliotis; Jeffery Moses; Adam C Salisbury; David J Cohen; John A Spertus; Suzanne V Arnold Journal: Circ Cardiovasc Qual Outcomes Date: 2017-12
Authors: Angela Lowenstern; Karen P Alexander; Neha J Pagidipati; C Larry Hill; Patricia A Pellikka; Lawton S Cooper; Brooke Alhanti; Udo Hoffmann; Daniel B Mark; Pamela S Douglas Journal: Circ Cardiovasc Qual Outcomes Date: 2022-04-04
Authors: Alexander R van Rosendael; A Maxim Bax; Inge J van den Hoogen; Jeff M Smit; Subhi J Al'Aref; Stephan Achenbach; Mouaz H Al-Mallah; Daniele Andreini; Daniel S Berman; Matthew J Budoff; Filippo Cademartiri; Tracy Q Callister; Hyuk-Jae Chang; Kavitha Chinnaiyan; Benjamin J W Chow; Ricardo C Cury; Augustin DeLago; Gudrun Feuchtner; Martin Hadamitzky; Joerg Hausleiter; Philipp A Kaufmann; Yong-Jin Kim; Jonathon A Leipsic; Erica Maffei; Hugo Marques; Pedro de Araújo Gonçalves; Gianluca Pontone; Gilbert L Raff; Ronen Rubinshtein; Todd C Villines; Heidi Gransar; Yao Lu; Jessica M Peña; Fay Y Lin; Leslee J Shaw; Jagat Narula; James K Min; Jeroen J Bax Journal: Eur Heart J Cardiovasc Imaging Date: 2022-01-24 Impact factor: 6.875