Prognostic Value of Normal Exercise Echocardiography in a One-Year Follow up

Document Type : Original Article


1 Department of Cardiology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran

2 Cardiovascular Research Center, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran

3 Department of Cardiac Surgery, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran


Background: Exercise echocardiography is a well-validated technique for the diagnosis of coronary artery disease. In addition to the diagnostic role, it also provides useful prognostic information. Objectives: The aim of this cross sectional study was to assess the prognosis of patients with negative exercise echocardiographic results over a one-year period follow-up. Patients and Methods: The outcomes of 336 patients who had normal exercise echocardiograms were examined. All clinical and exercise echocardiogram parameters were recorded. Patients were followed up for 1 year. End points were defined as cardiac death, non-fatal myocardial infarction, hospital admission for coronary artery disease, and coronary revascularization. Results: Mean age was 54.55 ± 10.34 years. 63.4 % were women. The most frequent risk factor was hypertension. There was no significant statistical difference between men and women regarding the prevalence of systemic hypertension, diabetes mellitus, and history of coronary artery bypass grafting. 5.67% of men and 8.9 % of women had positive exercise tolerance test for ischemia. Hemodynamic parameters, diastolic function, severity of mitral regurgitation, pulmonary artery pressures, peak strain rate were not significantly different between men and women, but rest strain rates were significantly lower in women. Total exercise times and exercise capacity were higher in men. After a 1-year follow-up there was no cardiac events and mortality. Conclusions: Patients with normal exercise echocardiogram results regardless of ischemia or chest pain during the test had excellent outcomes over a one-year follow-up.


  1. 1.Ryan T, Vasey CG, Presti CF, O'Donnell JA, Feigenbaum H, Armstrong WF. Exercise echocardiography: detection of coronary artery disease in patients with normal left ventricular wall motion at rest. J Am Coll Cardiol. 1988;11(5):993–9.

    1. Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS, et al. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on the Management of Patients With Chronic Stable Angina). J Am Coll Cardiol. 2003;41(1):159–68.
    2. McCully RB, Roger VL, Mahoney DW, Karon BL, Oh JK, Miller FA, Jr., et al. Outcome after normal exercise echocardiography and predictors of subsequent cardiac events: follow-up of 1,325 patients. J Am Coll Cardiol. 1998;31(1):144–9.
    3. Ismail G, Lo E, Sada M, Conant RD, Shapiro SM, Ginzton LE. Longterm prognosis of patients with a normal exercise echocardiogram and clinical suspicion of myocardial ischemia. Am J Cardiol. 1995;75(14):934–6.
    4. Al-Mallah M, Alqaisi F, Arafeh A, Lakhdar R, Al-Tamsheh R, Ananthasubramaniam K. Long term favorable prognostic value of negative treadmill echocardiogram in the setting of abnormal treadmill electrocardiogram: a 95 month median duration follow-up study. J Am Soc Echocardiogr. 2008;21(9):1018–22.
    5. Marwick TH, Mehta R, Arheart K, Lauer MS. Use of exercise echocardiography for prognostic evaluation of patients with known or suspected coronary artery disease. J Am Coll Cardiol. 1997;30(1):83–90.
    6. Bouzas-Mosquera A, Peteiro J, Broullon FJ, Alvarez-Garcia N, Mendez E, Perez A, et al. Value of exercise echocardiography for predicting mortality in elderly patients. Eur J Clin Invest. 2010;40(12):1122–30.
    7. Bouzas-Mosquera A, Peteiro J, Alvarez-Garcia N, Broullon FJ, Mosquera VX, Garcia-Bueno L, et al. Prediction of mortality and major cardiac events by exercise echocardiography in patients with normal exercise electrocardiographic testing. J Am Coll Cardiol. 2009;53(21):1981–90.
    8. Arruda-Olson AM, Juracan EM, Mahoney DW, McCully RB, Roger VL, Pellikka PA. Prognostic value of exercise echocardiography in 5,798 patients: is there a gender difference? J Am Coll Cardiol. 2002;39(4):625–31.
    9. Marwick TH, Anderson T, Williams MJ, Haluska B, Melin JA, Pashkow F, et al. Exercise echocardiography is an accurate and costefficient technique for detection of coronary artery disease in women. J Am Coll Cardiol. 1995;26(2):335–41.
    10. Kokkinos P, Myers J, Faselis C, Panagiotakos DB, Doumas M, Pittaras A, et al. Exercise capacity and mortality in older men: a 20- year follow-up study. Circulation. 2010;122(8):790–7.
    11. Dandel M, Hetzer R. Echocardiographic strain and strain rate imaging--clinical applications. Int J Cardiol. 2009;132(1):11–24.
    12. Abraham TP, Dimaano VL, Liang HY. Role of tissue Doppler and strain echocardiography in current clinical practice. Circulation. 2007;116(22):2597–609.
    13. Dandel M, Lehmkuhl H, Knosalla C, Suramelashvili N, Hetzer R. Strain and strain rate imaging by echocardiography - basic concepts and clinical applicability. Curr Cardiol Rev. 2009;5(2):133–48.
    14. Bjork Ingul C, Rozis E, Slordahl SA, Marwick TH. Incremental value of strain rate imaging to wall motion analysis for prediction of outcome in patients undergoing dobutamine stress echocardiography. Circulation. 2007;115(10):1252–9.
    15. Moonen M, Lancellotti P, Zacharakis D, Pierard L. The value of 2D strain imaging during stress testing. Echocardiography. 2009;26(3):307–14.