Predictors of negative exercise echocardiography in women with positive exercise electrocardiograms JACC March 19,2003 ABSTRACTS - Cardiac Function and Heart Failure 177A pacmg at each pacing site did not improve LV diastolic function. Conclusion: LVP and BVP improved LV systolic function in patients with heart failure regardless of the baseline rhythm. In patients with AF, only BVP improved LV diastolic function. These results indicate that BVP may be more beneficial than single-site LVP in patients with heart failure and AF. GROUPS #OF PATIENTS EXERCISE DURATlON(min) MET’s PEAK HR + SPECT, 210 8.6 * 2.3 10.9 f 2.8 153 f 14 30% Cl +SPECT, 60 6.8 * 2.2 8.9A2.7’ 146*13 <90% Cl - SPECT, 166 8.7 f 2.6 ll.li3.1 150*15 SO% Cl -SPECT, 27 6.0 * 2.2’ 8.7 * 2.5” 151 * 12 <90% Cl POSTER SESSION 1111 Exercise Testing: Cardiac Rehabilitation Monday, March 31, 2003, NoonQ:OO p.m. McCormick Place, Hall A Presentation Hour: 1:OO p.m.-2:OO p.m. 1111-59 Predictors of Negative Exercise Echocardiography in Women With Positive Exercise Electrocardiograms Amish J. Desai, Amogh Bhat, Dallit Bagha, Mrudula Guthikonda, Ezra A. Amsterdam University of California, Davis Medical Center, Sacramento, CA BACKGROUND: Exercise (Ex) electrocardiography (ECG) is the most widely used non- invawe test for evaluating symptoms suggestive of coronary artery disease (CAD). In women. however, Ex ECG has limited reliability due to an increased rate of false positive results. Therefore, a stress-imaging study is frequently the initial test for evaluation of chest pal” in women. We have previously reported that certain exercise test variables predict a negative Ex echocardlogram (Echo). To further enhance this predictive value, we report additional exercise test variables predictive of negative Ex Echo. METHODS We analyzed the results of simultaneous Ex Echo and Ex ECG in women with no known cardiac disease es part of the initial evaluation for chest pain suggestive of CAD. All patients (Pts) had a normal resting ECG and adequate exercise capacity by his- tory. All tests were symptom-limited utilizing a Bruce Protocol. A positive Ex Echo was defined es an Ex-induced regional wall motion abnormality and a positive Ex ECG was defined as Ex-induced 21 .O mm ST segment depression 60-80 msec after the J point. RESULTS: The study group comprised 415 consecutive women (mean age 54 years [31-901) evaluated by simultaneous Ex Echo and Ex ECG. Ex Echo was positive I” 11% (48/415) and negative in 88% (367/471). Ex ECG was positive in 26% (108/415) and negative in 74% (3071415). In 64% (69/108) Pts with a positive Ex ECG, Ex Echo was negative, suggesting a false positive Ex ECG. In this group of 69 Pts, non-Echo Ex test data associated with a negative Ex Echo included: 27 METS, double product z.25.000, ST depression cl.5 mm, no Ex-induced chest pain, ST segment resolution 4.7, no inducible ischemia occurred more (71% vs. 40%), with 95% predicted maximum heart rate more (24% vs. 9%) often in functionally impaired women (p=O.O02); despite similar disease prevalence. In Conclusion, among women referred for coronary angiography for suspected myocar- dial ischemia, marked functional impairment estimated by a simple estimate of functional capacity is associated with an adverse prognosis. Use of the DASI prior to exercise stress testing may stratify candidates for exercise testing or pharmacologic stress. ll 9 w 2.3.Year Event Rates % <4.8 4.8-7.4 7.5-9.9 >9.9 p value DASCestimated METS 29 13 10 7 0.0001 Exercise METS 25 19 14 7 0.03 L-l 1111-62 High Treadmill Workload in Patients With Exercise- Induced ST Depression Predicts a Negative Result on Exercise Echocardiography Amish J. Desai. Amogh Bhat, Daljit Bagha. Mrudula Guthikinda, Ezra A. Amsterdam, University of California, Davis Medical Center, Sacramento, CA BACKGROUND Although exercise (Ex) electrocardiography (ECG) IS the most com- monly employed initial test to assess patients with symptoms suggestive of coronary artery disease (CAD), it has limited diagnostic accuracy. Therefore, patients (Pts) with positive tests for myocardial ischemia are frequently referred for further evaluation by noninvasive stress Imaging such as Ex echocardiography (Echo). A negative Ex Echo is considered evidence of absence of high risk CAD and of low clinical risk. It has recently been shown that functional capacity is a strong predictor of prognosis. Thus, in a group of Pts with positive Ex ECG but high treadmill workload, we investigated the results of sec- ondary evaluation by Ex Echo.METHODS We analyzed the results of 140 consecutwe pts (110 males, 30 females; mean age 51 yrs [30-821) referred for Ex Echo after a posi- tive Ex ECG and a treadmill workload of 210 METS. All Pts had a normal resting ECG. Exercise tests utilized a Bruce protocol and were symptom-limited. A positwe Ex ECG was defined as Ex-induced 21 .O mm ST segment depression 60-80 msec after the J point and a positive Ex Echo was defined by an Ex-induced regional wall motion abnor- mality. RESULTS: Ex Echo was negative in 94% (131/140) of Pts and positive in 6% (9/ 140). CONCLUSIONS: Ex ECG performed to a high workload is highly predictive of a negative Ex Echo and thus low prognostic risk in Pts referred because of positive Ex ECG. Pts with ST depression on Ex ECG, who achieve at least 10 METS during treadmill Ex. may not require additional noninvasive or invasive evaluation. 1111-63 Impact of Obesity on Inflammation and Metabolic Syndrome in Coronary Patients and Effects of Cardiac Rehabilitation Carl J. Lavie, Richard V. Milani,Ali Morshedi, Ochsner Clinic Foundation, New Orleans, LA Background: Obesity is epidemic in the US and represents a major risk factor for CAD and type II diabetes. Limited data, however, exist on the eflects of obesity on such risk factors es inflammation and components of the metabolic syndrome (MS) es defined by ATP Ill in CAD patients, and the effects of cardiac rehabilitation and exercise training programs &RET) in these patients.