Exercise stress echocardiography with tissue Doppler imaging in risk stratification of mild to moderate XXXX .

@entity1 @entity308 @entity9400 @entity299 @entity472 @entity204 @entity65
UNASSIGNED: Background @entity1 with mild to moderate @entity472 ( @entity472 ) seem to have a worse outcome than commonly expected. Early identification of subjects who may develop a rapid disease progression or @entity65 is critical in order to apply adequate risk management. Study design  Observational prospective single-centre study. Objective  To determine the prognostic role of exercise stress echocardiography (ESE) in @entity1 with mild and moderate asymptomatic @entity472 . @entity1  Ninety consecutive @entity1 (mean age 74      12  years) with isolated mild and moderate @entity472 were enrolled into the study protocol over a 20  months period. Follow-up time was 12  months. Methods  A complete echocardiographic study with tissue Doppler imaging (TDI) was performed at baseline and during semi-supine symptom-limited exercise test to evaluate: (1) the occurrence of symptoms, (2) ST segment changes, (3) transaortic pressure gradient, (4) the E/A ratio, (5) the E/e' ratio and (6) the systolic pulmonary artery pressure. Main outcome measures  During the 1  year follow-up time, we evaluated the occurrence of adverse @entity299 , defined as any of the following: (1) cardio-vascular hospitalization; (2) requirement for aortic valve replacement; (3) @entity204 . Results  During follow-up, three @entity1 died, 11 underwent aortic valve replacement and 26 had cardiovascular hospitalizations. On univariate analysis, @entity1 who exhibited symptoms during exercise (HR 2.93, p  =  0.003); the occurrence of a >= 2  mm exercise-induced @entity308 (HR 3.12, p  =  0.001); a >= 15  mmHg increase in mean transaortic pressure gradient during exercise (HR 2.77, p  =  0.001); a >= 50  mmHg exercise-induced increase in systolic pulmonary artery pressure (HR 2.90, p  =  0.009); an exercise-induced pseudo-normalization of the @entity9400 (HR 7.50, p  =  0.0001) and, particularly, a >= 15 exercise-induced increase in the E/e' ratio (HR 7.69, p  =  0.0001) had a significantly higher risk of @entity299 during the follow-up time. On multivariate analysis, only the latter covariate (HR 6.04, p  =  0.009) was independently associated with adverse @entity299 . Conclusions  A >= 15 stress-induced increase in E/e' ratio is highly predictive of @entity299 in @entity1 with mild to moderate @entity472 . Assessment of diastolic function using TDI during ESE provides additional prognostic information in such @entity1 .
