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

BackgroundThe non-invasive prognostic assessment of coronary artery disease in patients over 70 years old is an important goal in daily clinical practice.ObjectivesTo 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.MethodsThree hundred seventy nine patients (226 women; mean age of 75.9 ± 4.6 years) underwent dipyridamole stress echocardiography.ResultsFollow-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.ConclusionsRisk 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.