Woodward William, Johnson Casey L, Krasner Samuel, O'Driscoll Jamie, McCourt Annabelle, Dockerill Cameron, Balkhausen Katrin, Chandrasekaran Badrinathan, Firoozan Soroosh, Kardos Attila, Sabharwal Nikant, Sarwar Rizwan, Senior Roxy, Sharma Rajan, Wong Kenneth, Augustine Daniel X, Leeson Paul
Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK.
Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Eur Heart J Cardiovasc Imaging. 2025 Jan 31;26(2):187-196. doi: 10.1093/ehjci/jeae291.
Stress echocardiography is widely used to assess patients with chest pain. The clinical value of a positive or negative test result to inform on likely longer-term outcomes when applied in real-world practice across a healthcare system has not been previously reported.
Five thousand five hundred and three patients recruited across 32 UK NHS hospitals between 2018 and 2022, participating in the EVAREST/BSE-NSTEP prospective cohort study, with data on medical outcomes up to 2023 available from NHS England were included in the analysis. Stress echocardiography results were related to outcomes, including death, procedures, hospital admissions, and relevant cardiovascular diagnoses, based on Kaplan-Meier analysis and Cox proportional hazard ratios (HRs). Median follow-up was 829 days (interquartile range 224-1434). A positive stress echocardiogram was associated with a greater risk of myocardial infarction [HR 2.71, 95% confidence interval (CI) 1.73-4.24, P < 0.001] and a composite endpoint of cardiac-related mortality and myocardial infarction (HR 2.03, 95% CI 1.41-2.93, P < 0.001). Hazard ratios increased with ischaemic burden. A negative stress echocardiogram identified an event-free 'warranty period' of at least 5 years in patients with no prior history of coronary artery disease and 4 years for those with disease.
In real-world practice, the degree of myocardial ischaemia recorded by clinicians at stress echocardiography correctly categorizes risk of future events over the next 5 years. Reporting a stress echocardiogram as negative correctly identifies patients with no greater than a background risk of cardiovascular events over a similar time period.
负荷超声心动图广泛应用于胸痛患者的评估。此前尚未有关于在医疗系统的实际应用中，负荷超声心动图检查结果呈阳性或阴性对预测长期预后的临床价值的报道。
纳入2018年至2022年间在英国32家国民保健服务（NHS）医院招募的5503例患者，这些患者参与了EVAREST/BSE-NSTEP前瞻性队列研究，分析的数据来自英国国家医疗服务体系（NHS）英格兰地区，涵盖截至2023年的医疗结局。基于Kaplan-Meier分析和Cox比例风险比（HR），将负荷超声心动图结果与包括死亡、手术、住院以及相关心血管诊断等结局相关联。中位随访时间为829天（四分位间距224 - 1434天）。负荷超声心动图阳性与心肌梗死风险增加相关[HR 2.71，95%置信区间（CI）1.73 - 4.24，P < 0.001]，以及与心脏相关死亡率和心肌梗死的复合终点相关（HR 2.03，95% CI 1.41 - 2.93，P < 0.001）。风险比随缺血负担增加而升高。负荷超声心动图阴性在无冠心病病史的患者中确定了至少5年的无事件“保证期”，在有冠心病病史的患者中为4年。
在实际临床实践中，临床医生在负荷超声心动图检查中记录的心肌缺血程度能够正确分类未来5年发生事件的风险。报告负荷超声心动图结果为阴性可正确识别在相似时间段内心血管事件风险不高于背景风险的患者。
