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Background Elderly patients with suspected or known coronary artery disease are often referred for pharmacological stress testing. Data on the value of exercise echocardiography (ExEcho) for predicting outcome (particularly all- cause mortality) in these patients are scarce. Methods Peak treadmill ExEcho was performed in 2159 patients ‡ 70 years of age with known or suspected coronary artery disease. Left ventricular wall motion was evaluated at baseline and with exercise, and the increase in wall motion score index from rest to peak exercise (DWMSI) was calculated. Ischaemia was diagnosed when new or worsening wall motion abnormalities developed with exercise. The end points were all-cause mortality and major cardiac events (cardiac death or myocardial infarction). Results Ischaemia developed in 844 patients (38Æ6%) during exercise. Over a mean follow-up of 3Æ5 ± 3Æ1 years, 439 deaths occurred. The cumulative 5-year mortality rate was 29Æ3% in patients with ischaemia versus 16Æ8% in those without ischaemia (P < 0Æ001). After covariate adjustment, DWMSI remained an independent predictor of mortality [hazard ratio (HR) 2Æ37, 95% confidence interval (CI) 1Æ66–3Æ39, P < 0Æ001] and major cardiac events (HR 3Æ48, 95% CI 2Æ11–5Æ74, P < 0Æ001). These results remained significant even in patients with chronotropic incompetence. When added to a model with clinical, resting echocardiographic and exercise electrocardiogram variables, ExEcho results provided incremental value for the prediction of both end points (P < 0Æ001). Conclusions ExEcho is feasible in elderly patients with suspected or known coronary artery disease and provides useful information for risk stratification in these patients. [ABSTRACT FROM AUTHOR]

The association of atrial fibrillation (AF) with coronary artery disease (CAD) remains controversial. In addition, the relation of AF to myocardial ischemia and outcomes in patients with known or suspected CAD referred for exercise stress testing has been poorly explored. In this study, 17,100 patients aged ≥50 years with known or suspected CAD who underwent exercise electrocardiography (n = 11,911) or exercise echocardiography (n = 5,189) were evaluated. End points were all-cause mortality, nonfatal myocardial infarction, and coronary revascularization. Overall, 619 patients presented with AF at the time of the tests. Patients with AF who had interpretable electrocardiograms had a lower likelihood of exercise-induced ischemic ST-segment abnormalities (adjusted odds ratio 0.51, 95% confidence interval 0.34 to 0.76, p = 0.001), and those with AF who underwent exercise echocardiography had a lower likelihood of new or worsening exercise-induced wall motion abnormalities (adjusted odds ratio 0.62, 95% confidence interval 0.44 to 0.87, p = 0.006). During a mean follow-up period of 6.5 ± 3.9 years, 2,364 patients died, 1,311 had nonfatal myocardial infarctions, 1,615 underwent percutaneous coronary intervention, and 922 underwent coronary artery bypass surgery. The 10-year mortality rate was 43% in patients with AF compared to 19% in those without AF (p <0.001). In multivariate analysis, AF remained an independent predictor of all-cause mortality (adjusted hazard ratio 1.45, 95% confidence interval 1.20 to 1.76, p <0.001), but not of nonfatal myocardial infarction or coronary revascularization. In conclusion, despite being associated with an apparently lower likelihood of myocardial ischemia, AF was an independent predictor of all-cause mortality in patients with known or suspected CAD referred for exercise stress testing. [Copyright &y& Elsevier]