[en] Background and objectives: The prognostic value of exercise echocardiography in patients with normal exercise electrocardiographic testing has not been characterized. Our aim was to assess the value of exercise echocardiography for predicting outcome in patients with known or suspected coronary artery disease and normal exercise electrocardiogram. Methods: We studied 4004 consecutive patients (2358 men, mean age [± SD] 59.6±12.5 years) with interpretable electrocardiograms who underwent treadmill exercise echocardiography and did not develop chest pain or ischemic electrocardiographic abnormalities during the tests. Wall motion score index (WMSI) was evaluated at rest and with exercise, and the difference (?WMSI) was calculated. Ischemia was defined as the development of new or worsening wall motion abnormalities with exercise. End points were all-cause mortality and major cardiac events. Results: Overall, 669 patients (16.7%) developed ischemia with exercise. During a mean follow-up of 4.5±3.4 years, 313 patients died, and 183 patients had a major cardiac event before any revascularization procedure. The 5-year mortality and major cardiac event rates were 6.4% and 4.2% in patients without ischemia vs. 12.1% and 10.1% in those with ischemia, respectively (p<0.001). In the multivariate analysis, ?WMSI remained an independent predictor of mortality (hazard ratio [HR] 2.73, 95% confidence interval [CI] 1.40-5.32, p=0.003) and major cardiac events (HR 3.59, 95% CI 1.42-9.07, p=0.007). The addition of the exercise echocardiography results to the clinical, resting echocardiographic and exercise hemodynamic data significantly increased the global ?2 of the models for the prediction of mortality (p=0.005) and major cardiac events (p=0.009). Conclusions: Exercise echocardiography provides significant prognostic information for predicting mortality and major cardiac events in patients with interpretable electrocardiogram and normal exercise electrocardiographic testing.

[gl] Antecedentes e obxectivos: O valor pronóstico da ecocardiografía de exercicio en pacientes cunha ergometría convencional normal non foi avaliado. O noso obxectivo foi estuda-lo valor da ecocardiografía de exercicio para predicir mortalidade e eventos cardíacos graves en pacientes con enfermidade coronaria coñecida ou sospeitada e cunha ergometría convencional negativa. Métodos: Estudamos a 4004 pacientes consecutivos (2358 homes, idade media 59,6±12,5 anos) cun electrocardiograma basal interpretable que foron sometidos a ecocardiografía de exercicio en cinta rodante e non desenrolaron dor torácica ou cambios electrocardiográficos isquémicos durante os tests. Calculouse un índice de motilidade segmentaria (IMS) en repouso e en exercicio así como a diferenza entre ambos valores (?IMS). A isquemia definiuse coma a aparición de novas alteracións da contractilidade segmentaria ou o empeoramento das previamente presentes. Os endpoints foron a mortalidade total e os eventos cardíacos graves (morte cardíaca ou infarto non fatal). Resultados: En total, 669 pacientes (16,7%) desenrolaron isquemia co exercicio. Durante un seguimento de 4,5±3,4 años, 313 pacientes faleceron, e 183 pacientes presentaron un evento cardíaco grave antes de calquera procedemento de revascularización coronaria. A tasa de mortalidade e de eventos cardíacos graves a 5 anos foi do 6,4% e 4,2% en pacientes sen isquemia fronte ó 12,1% e 10,1% en aqueles con isquemia, respectivamente (p <0,001). No análise multivariado, o ?IMS resultou predictor independente de mortalidade (hazard ratio [HR] 2,73, intervalo de confianza [IC] do 95% 1,40-5,32, p = 0,003) e de eventos cardíacos graves (HR 3,59, IC 95% 1,42-9,07, p = 0,007) e incrementou o valor do ?2 global dos modelos para a predición de mortalidade (p = 0,005) e de eventos cardíacos graves (p = 0,009). Conclusións: A ecocardiografía de exercicio proporciona información pronóstica significativa para a predición de mortalidade e de eventos cardíacos graves en pacientes con electrocardiograma interpretable e ergometría convencional normal.