Stress echo and long-term prognosis in patients with chest pain
Feb 11, 2025
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Attila Kardos, a consultant cardiologist and clinical lead at Milton Keynes University Hospital, shares his expertise on stress echocardiography and its role in diagnosing chest pain. He discusses the historical significance of this diagnostic tool and its inclusion in cardiovascular guidelines. The conversation dives into a meta-analysis revealing the long-term prognostic value of stress echo and its effectiveness compared to other cardiac imaging techniques. Attila highlights key findings from studies involving over 16,500 patients, emphasizing the importance of interpreting test results for managing cardiovascular risks.
Stress echocardiography serves as a crucial non-invasive tool to evaluate heart function under stress, enhancing diagnosis for patients with chest pain.
Long-term studies demonstrate that positive stress echo results significantly increase the risk of major cardiovascular events, underscoring its prognostic value.
Deep dives
Understanding Stress Echocardiography
Stress echocardiography is a non-invasive diagnostic tool that assesses the heart's blood supply by putting it under stress, simulating conditions such as exercise. Developed over 50 years ago, it helps evaluate patients experiencing chest pain or breathlessness by monitoring their heart's contraction and blood flow during stress tests. This method is considered safe, analogous to the physical exertion of climbing a few flights of stairs, and can utilize various stressors including treadmill tests and pharmacological agents. Recent guidelines have recognized stress echocardiography as a valuable diagnostic tool for patients at moderate to high risk of coronary artery disease, establishing its relevance within the current arsenal of chest pain assessment techniques.
Long-Term Prognostic Value of Stress Echocardiography
The recent meta-analysis conducted by a research team aimed to investigate the long-term outcomes associated with stress echocardiography findings in patients with suspected coronary artery disease. This study encompassed a significant number of patients, focusing on how positive and negative stress echo results relate to major adverse cardiovascular events over extended follow-up periods, averaging 31 months. While previous studies highlighted short-term prognostic indicators, this research extends the understanding of stress echocardiography's effectiveness in predicting outcomes, emphasizing the importance of its results beyond just immediate assessments. A notable finding revealed that positive stress echo results correlated with a two-fold increase in the risk of major cardiovascular events compared to negative results, highlighting its predictive capabilities.
Comparative Effectiveness of Cardiac Imaging Techniques
When comparing stress echocardiography with other cardiac imaging modalities like perfusion scintigraphy and cardiac MRI, the outcomes in terms of prognosis were found to be quite similar across these methods. All three techniques effectively assess patients with chest pain and yielded comparable rates of cardiovascular events based on whether the tests returned positive or negative results. Stress echocardiography is particularly advantageous due to its bedside usability, lack of radiation exposure, and cost-effectiveness compared to the alternatives. This reinforces the position of stress echocardiography as a powerful tool in clinical practice for the functional assessment of patients at risk of heart disease.
In this episode of the Heart podcast, Digital Media Editor, Professor James Rudd, is joined by Professor Attila Kardos from Milton Keynes University Hospital, UK. They discuss his paper on the prognostic potential of stress echocardiography. If you enjoy the show, please leave us a podcast review wherever you get your podcast - it's very helpful to us!