Prognostic value of exercise echocardiography in 2,632 patients >= 65 years of age

OBJECTIVES We sought tu determine the prognostic value of exercise echocard iography in the elderly. BACKGROUND Limited data exist regarding the prognostic value of exercise te sting in the elderly, a population which may be less able to exercise and i s at increased risk of cardiac death. METHODS Follow-up (2.9 +/- 1:7 years) was obtained in 2,632 patients greate r than or equal to 65 years who underwent exercise echocardiography. RESULTS There were 1,488 (56%) men and 1,144 (44%) women (age 72 +/- 5 year s). The rest ejection fraction was 56 +/- 9%. Rest wall motion abnormalitie s were present in 935 patients (36%). The mean work load was 7.7 +/- 2.3 me tabolic equivalents (METs) fur men and 6.5 +/- 1.9 METs for women. New or w orsening wall motion abnormalities developed with stress in 1,082 patients (41%). Cardiac events included cardiac death in 68 patients and nonfatal my ocardial infarction in 80 patients. The addition of the exercise electrocar diogram to the clinical and rest echocardiographic model provided increment al information in predicting both cardiac events (chi-square = 77 to chi-sq uare = 86, p = 0.003) and cardiac death (chi-square = 71 to chi-square = 86 , p < 0.0001). The addition of exercise echocardiographic variables, especi ally the change in left ventricular end-systolic volume with exercise and t he exercise ejection fraction, further improved the model in terms of predi cting cardiac events (chi-square = 86 to chi-square = 108, p < 0.0001) and cardiac death (chi-square = 86 to chi-square = 99, p = 0.004). CONCLUSIONS Exercise echocardiography provides incremental prognostic infor mation in patients greater than or equal to 65 years of age. The best model included clinical, exercise testing and exercise echocardiographic variabl es. (J Am Coll Cardiol 2001;37:1036-41) (C) 2001 by the American College of Cardiology.