Argulian et al identified factors that can predict the presence of inducible ischemia in a patient referred to stress echocardiography because of exertional dyspnea without chest pain. The authors are from St. Luke's-Roosevelt Hospital Center and Columbia University in New York City.
Patient selection: exertional dyspnea without chest pain
Assessment: stress echocardiography (either exercise or dobutamine as stressor)
Predictors of inducible ischemia:
(1) male sex (odds ratio 2.8)
(2) history of coronary artery disease (odds ratio 3.5)
(3) resting wall motion abnormalities (odds ratio 16.6)
The risk of inducible ischemia increases with the number of risk factors present. The cumulative product of all 3 predictors if present is 162.7.
Patients without inducible ischemia can have a worse prognosis if they have diastolic dysfunction with diastolic heart failure. These patients have:
(1) left atrial enlargement
(2) low E' velocities
(3) pulmonary hypertension
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