Does ischemic stress echocardiography study in subjects with non-obstructive coronary artery disease predicts worse cardiovascular prognosis?

Many patients with signs of ischemia in stress echocardiography (SE) do not have obstructive coronary artery disease (CAD). There is concern that subjects with abnormal SE results without significant CAD have a worse prognosis than patients with normal SE.

The aim of this study was to examine the cardiovascular prognosis and mortality of patients with ischemic SE test and normal or non-obstructive CAD.

A retrospective cohort study of patients with ischemic SE test who demonstrated a normal coronary arteries or non-significant CAD by coronary catheterization or computerized tomography angiography were compared to patients with normal SE study, matched by distribution of age, gender, and by the year that the test was performed for the rate of all-cause mortality and mayor adverse cardiac events (MACE).

There were 55 out of 168 patients with ischemic SE that had normal or non-significant CAD (64 ± 9 years, 54% females). During a mean follow up of 7.9 ± 2.6 years, MACE was higher in ischemic SE group than the non–ischemic group (15% and 7%, respectively). The most common MACE component in the ischemic SE subjects was heart failure (11% and 2% for ischemic SE group and non-ischemic SE group, respectively) (HR 2.854). The rate of all-cause mortality was also higher in the ischemic SE group than the non-ischemic SE group (3.1% and 2.1%, respectively) By multivariate analysis the most powerful parameter that predicted all-cause mortality was hypertension (HR 1.195) and diabetes mellitus (HR 1.548).

The outcome of patients with ischemic SE and normal coronary arteries or non-obstructive CAD is worse for patients with normal SE. According to these findings patients with ischemic SE results and normal coronary arteries or non-obstructive CAD may benefit from different management that should include frequent medical follow up and tight control of risk factors.