Prediction of outcomes in hypertensive patients with suspected coronary disease

Thomas H. Marwick, Colin Case, Stephen Sawada, Charles Vasey, James D. Thomas

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Stress echocardiography has been shown to improve the diagnosis of coronary artery disease in the presence of hypertension, but its value in prognostic evaluation is unclear. We sought to determine whether stress echocardiography could be used to predict mortality in 2363 patients with hypertension, who were followed for up to 10 years (mean 4.0 ± 1.8) for death and revascularization. Stress echocardiograms were normal in 1483 patients (63%), 16% had resting left ventricular (LV) dysfunction alone, and 21% had ischemia. Abnormalities were confined to one territory in 489 patients (21%) and to multiple territories in 365 patients (15%). Cardiac death was less frequent among the patients able to exercise than among those undergoing dobutamine echocardiography (4% versus 7%, P<0.001). The risk of death in patients with a negative stress echocardiogram was <1% per year. Ischemia identified by stress echocardiography was an independent predictor of mortality in those able to exercise (hazard ratio 2.21, 95% confidence intervals 1.10 to 4.43, P=0.0001) as well as those undergoing dobutamine echo (hazard ratio 2.39, 95% confidence intervals 1.53 to 3.75, P=0.0001); other predictors were age, heart failure, resting LV dysfunction, and the Duke treadmill score. In stepwise models replicating the sequence of clinical evaluation, the results of stress echocardiography added prognostic power to models based on clinical and stress-testing variables. Thus, the results of stress echocardiography are an independent predictor of cardiac death in hypertensive patients with known or suspected coronary artery disease, incremental to clinical risks and exercise results.

Original languageEnglish
Pages (from-to)1113-1118
Number of pages6
JournalHypertension
Volume39
Issue number6
DOIs
StatePublished - 2002

Fingerprint

Stress Echocardiography
Coronary Disease
Dobutamine
Left Ventricular Dysfunction
Exercise
Coronary Artery Disease
Ischemia
Confidence Intervals
Hypertension
Mortality
Echocardiography
Heart Failure

Keywords

  • Coronary artery disease
  • Echocardiography
  • Hypertension, essential
  • Mortality
  • Stress

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Prediction of outcomes in hypertensive patients with suspected coronary disease. / Marwick, Thomas H.; Case, Colin; Sawada, Stephen; Vasey, Charles; Thomas, James D.

In: Hypertension, Vol. 39, No. 6, 2002, p. 1113-1118.

Research output: Contribution to journalArticle

Marwick, Thomas H. ; Case, Colin ; Sawada, Stephen ; Vasey, Charles ; Thomas, James D. / Prediction of outcomes in hypertensive patients with suspected coronary disease. In: Hypertension. 2002 ; Vol. 39, No. 6. pp. 1113-1118.
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