Risk stratification by accelerated high-dose dipyridamole stress echocardiography in patients over 70 years of age.

Background: The non-invasive prognostic assessment of coronary artery disease in patients over 70 years old is an important goal in daily clinical practice.

Objectives: To retrospectively assess the feasibility, the positive and negative predictive values and the accuracy of accelerated high-dose dipyridamole stress echocardiography in patients over 70 years old.

Methods: Three hundred seventy nine patients (226 women; mean age of 75.9±4.6 years) underwent dipyridamole stress echocardiography.

Results: Follow-up data were available for 313 patients (mean follow-up duration 21±15.7 months). Overall feasibility was 97%. Positive predictive values were 30% and 40% for 6 and 12 months of follow-up, respectively. Negative predictive values were 97.7% and 96.7% for 6 and 12 months of follow-up, respectively. Accuracy values were 95.5% and 94.9% for 6 and 12 months of follow-up, respectively. Among the clinical variables, dyslipidemia (OR 5.3; CI 95% 1.3-20.9; p=0.016), coronary artery disease (OR 4.2; CI 95% 1.3-13.3; p=0.014) and a positive stress echo response (OR 9.0; CI 95% 1.7-49.1; p=0.011) were independently associated with the occurrence of a cardiovascular event. A Cox regression model showed that male gender and a positive stress echo response significantly predicted death.

Conclusions: Risk stratification with accelerated high-dose dipyridamole stress echocardiography is feasible in patients over 70 years old. A positive stress echo response, the presence of coronary artery disease, and dyslipidemia positively predicted the occurrence of cardiovascular events. Male gender and a positive stress echo response significantly predicted death.