Treadmill exercise echocardiography as a predictor of events in patients with left ventricular hypertrophy.

Background: Exercise echocardiography (EE) is recommended for patients with known/suspected coronary artery disease (CAD) and electrocardiogram (ECG) abnormalities. Left ventricular hypertrophy (LVH) is associated with worse outcome and patients with LVH have frequently resting ECG abnormalities. We sought to assess the value of EE for predicting outcome in patients with known/suspected CAD and LVH.

Methods: Retrospective analysis over 1,058 patients, classified according to the presence (n = 557) or absence (n = 501) of LVH (LV mass > or =163 g for women, > or =225 g for men) who underwent EE. Wall motion score index (WMSI) was evaluated at rest and with exercise. Ischemia was defined as the development of new or worsening wall motion abnormalities (WMA) with exercise. The endpoints were all-cause mortality and major cardiac events (MACE). Overall, 352 patients (33%) developed new/worsening WMA.

Results: During a follow-up of 4.6 +/- 4.0 years, 178 patients died and 129 had a MACE. The 5-year mortality and MACE rates were 6.4 and 7.1% in patients without ischemia vs. 15.3 and 13.6% in those with ischemia, respectively (P < 0.001). In the multivariable analysis, LV mass (hazard ratio (HR) 1.03, 95% confidence interval (CI) 1.02-1.04, P = 0.008) and DeltaWMSI (HR 1.94, 95% CI 1.12-3.35, P = 0.02) were independent predictors of mortality. DeltaWMSI was also an independent predictor of MACE in the overall population (P = 0.002) and in patients with LVH (P = 0.04).

Conclusion: LV mass independently predicts mortality, even when EE data are considered. EE provides significant information for predicting events in patients with LVH and known/suspected CAD.