ECHOCARDIOGRAPHIC CORRELATES OF SURVIVAL IN PATIENTS WITH CHEST PAIN

Objectives. This study sought to identify echocardiographic predictors of survival in patients with chest pain and to assess the utility of qualitative echocardiographic data in the prognostic stratification of this cohort. Background. The potential usefulness of echocardiographi c data in prognostic stratification of patients with acute chest pain is unclear, in part because of the qualitative nature of routinely ava ilable echocardiographic readings. Methods. The study group comprised 513 patients who under went transthoracic two-dimensional and Doppler echocardiography within 1 month of emergency department visits for acu te chest pain. Clinical and electrocardiographic (ECG) data were recor ded for these patients at the time of their initial evaluations, and e chocardiographic data were subsequently obtained from the official hos pital reports. Follow-up survival rate data were obtained from medical records or the Massachusetts Bureau of Vital Statistics. Results. A m ean of 28.5 months after the index visit, 102 patients (20%) had died, including 58 (57%) for whom the primary cause of death was cardiovasc ular. In analysis of routinely available qualitative echocardiographic data, left ventricular size and function, the presence of regional wa ll motion abnormalities, mitral regurgitation and structural abnormali ties of the mitral valve were significant univariate correlates of bot h overall mortality and death from cardiovascular causes. Severe left ventricular dysfunction (adjusted rate ratio 3.8, 95% confidence inter val [CI] 1.9-7.5) and moderate or severe mitral regurgitation (adjuste d rate ratio 2.4, 95% CI 1.5-3.7) were independent predictors of morta lity in a multivariate Cox regression analysis that adjusted for clini cal and ECG variables. Moderate or severe left ventricular dysfunction and mitral regurgitation were predictors of mortality in the subset o f patients without acute myocardial infarction. Conclusions. Qualitati ve echocardiographic reports of left ventricular dysfunction and mitra l regurgitation were independent correlates of prognosis in patients w ith acute chest pain, including patients without acute myocardial infa rction. Further data are needed to assess the generalizability of thes e findings and the implications for use of this diagnostic technology.