Long-term prognostic value of contemporary stress echocardiography in patients with suspected or known coronary artery disease: systematic review and meta-analysis

Journal article

Background: Long-term outcome of contemporary stress echocardiography has not been systematically assessed. Objective: To evaluate the association between results of stress echocardiography and patients’ outcomes with suspected coronary artery disease using randomised controlled trials. Methods: Multiple electronic databases were searched for studies evaluating long-term outcome (>12 months) of stress echocardiography in patients suspected of coronary artery disease since year 2000. A common-effect model was used to derive pooled estimates. The primary outcome was a composite of all-cause mortality or cardiovascular death and non-fatal myocardial infarction, depending on the definition applied in individual trials, termed as major adverse cardiovascular event (MACE). Secondary outcome was all-cause mortality. Positive stress echocardiography result was defined as inducible ischaemia in at least one of the 17 left ventricular segments and negative stress echocardiography with no inducible ischaemia. Results: Among a total of six trials, 16 581 subjects underwent either pharmacological or treadmill stress echocardiography, a median follow-up of 31 months (range 21–101). The annual event rate was 1.76% for the composite MACE and 1.35% for all-cause mortality. Compared with negative stress echocardiography, positive stress echocardiography was associated with an increased risk of the MACE and all-cause mortality with an annual event rate of 1.99% vs 1.54% (OR 2.04, 95% CI 1.79 to 2.33) and 1.68% vs 1.02% (OR 2.06, 95% CI 1.80 to 2.35), respectively. Conclusion: Positive stress echocardiography results were associated with poorer long-term MACE and all-cause mortality. Stress echocardiography results may provide a useful long-term guidance in intensifying preventative treatment in patients with suspected coronary artery disease. PROSPERO registration number: CRD42023416766.

Authors: Ihekwaba, U; Johnson, N; Choi, JS; Savarese, G; Orsini, N

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: BMJ Publishing Group
• Journal: Heart
• Article number: heartjnl-2024-324534
• Publication date: 2024-08-23
• Acceptance date: 2024-07-31
• DOI: 10.1136/heartjnl-2024-324534
• EISSN: 1468-201X
• ISSN: 1355-6037
• Language: English
• Keywords: Coronary Vessels; Echocardiography; Diagnostic Imaging; Chest Pain; Meta-Analysis