Long-term prognostic value of exercise echocardiography compared with exercise Tl-201, ECG, and clinical variables in patients evaluated for coronaryartery disease

Background-The accuracy of exercise echocardiography and Tl-201 single phot on emission computed tomography (SPECT) is similar in the diagnosis of coro nary artery disease (CAD). However, comparative data on long-term prognosis are lacking. Methods and Results-Clinical variables and exercise, echocardiographic, and Tl-201 tomographic parameters were studied in 248 patients (age, 56+/-12 y ears [mean+/-SD]; 189 men) who underwent simultaneous treadmill exercise Tl -201 SPECT and echocardiography. Follow-up was obtained in 225 patients (91 %) at a mean of 3.7+/-2.0 years. A total of 64 cardiac events occurred. Wit h the use of stepwise logistic regression, 4 models simulating clinical str ess testing scenarios were evaluated in the prediction of all cardiac event s, ischemic events, and/or cardiac death. The best clinical models were exe rcise echocardiography with exercise ECG and exercise Tl-201 SPECT with exe rcise EGG. Both models were comparable in the prediction of cardiac events. For the exercise echocardiography model, exercise wall motion score index and induction of ischemia were the strongest predictors of events with ORs of 2.63 per unit increment (95% CI, 1.34 to 5.17; P=0.005) and 4.1 (95% CI, 1.32 to 12.79; P=0.015), respectively. For the model with exercise Tl-201 SPECT, the strongest predictor was ischemic perfusion defect (OR, 4.93; 95% CI, 1.72 to 14.08; P=0.003). The absence of ST changes during exercise dec reased the risk of events. For the prediction of ischemic events and/or car diac death, echocardiographic and Tl-201 parameters were the only predictiv e variables. Conclusions-In patients evaluated for CAD, exercise echocardiography and Tl -201 combined with ECG variables provide comparable prognostic information and can be used interchangeably for risk stratification.