IMPACT OF VALVULAR REGURGITATION AND VENTRICULAR DYSFUNCTION ON LONG-TERM SURVIVAL IN PATIENTS WITH CHEST PAIN

Doppler echocardiography is often used in evaluating patients with che st pain, but information on prognostic value of this testing and data to help guide selective use are limited. We prospectively studied 448 patients admitted from the emergency department for acute chest pain t o assess the utility of qualitative echocardiographic data in predicti ng long-term survival and the incremental value of this information ov er routine clinical and electrocardiographic data. Doppler echocardiog rams, recorded an average of 21 hours after presentation, were analyze d independently by 2 echocardiographers for global left and right vent ricular function and valvular disease. Regional function was assessed by wall motion index. Data on long-term survival were collected with a n average follow-up of 35.0 +/- 12.1 months. In univariate Cox regress ion analysis, left ventricular function and size, wall motion index, r ight ventricular function, and aortic, mitral, and tricuspid insuffici ency were significant predictors of total and cardiovascular mortality . In multivariate analysis, moderate or severe left ventricular dysfun ction (mortality rate ratio 3.2, 95% confidence intervals 1.8 to 5.8) and more than mild valvular regurgitation (mortality rate ratio 2.0, 9 5% confidence interval 1.1 to 3.6) were independent predictors of mort ality in a model adjusted far clinical and electrocardiographic data. These factors were more common in patients aged > 60 years, in those w ith prior acute myocardial infarction or angina, and in chose with rol es on physical examination. In the absence of these clinical character istics, only 8 of 124 patients (7%) had moderate or severe left ventri cular dysfunction or valvular regurgitation. In patients with moderate or severe regurgitation, a murmur was noted on the admission physical examination in 41 of 69 cases (59%). We conclude that echocardiograph ic evidence of moderate or severe left ventricular dysfunction or valv ular regurgitation identifies a high-risk group for overall and cardio vascular mortality in patients with chest pain, and this evidence may not be defected clinically, (C) 1997 by Excerpta Medica, Inc.