STRESS echocardiography reliably predicts long-term cardiovascular outcomes, distinguishing high-risk individuals from those with background risk over a five-year period in real-world practice.
Stress echocardiography is a widely used diagnostic tool for assessing chest pain, but its ability to predict longer-term cardiovascular outcomes in a real-world clinical setting across a healthcare system has not been previously evaluated. The UK-based EVAREST study aimed to address this knowledge gap by examining the predictive value of positive and negative stress echocardiogram results for future cardiovascular events.
Data were analysed from 5503 patients recruited between 2018 and 2022 across 32 UK NHS hospitals, with follow-up data collected up to 2023 via NHS England. Using Kaplan-Meier analysis and Cox proportional hazard models, the study assessed the relationship between stress echocardiogram results and outcomes, including myocardial infarction, cardiac-related death, and hospital admissions. The median follow-up duration was 829 days (IQR 224–1434). A positive stress echocardiogram was strongly associated with a higher risk of myocardial infarction (hazard ratio [HR]: 2.71; 95% 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). Risk stratification improved with higher ischaemic burden. Conversely, a negative stress echocardiogram predicted an event-free period of up to five years in patients without prior coronary artery disease and four years in those with pre-existing disease.
These findings confirm the clinical utility of stress echocardiography in categorising cardiovascular risk in real-world settings. A positive test result provides critical information to guide timely interventions in high-risk individuals, while a negative result offers reassurance and supports conservative management for low-risk patients. Future research should explore integration with newer imaging techniques and extended follow-up periods to enhance risk prediction further. This evidence reinforces the role of stress echocardiography as an essential component of cardiovascular care, offering a robust, non-invasive approach to risk stratification that benefits patients and healthcare systems alike.
Reference
William Woodward et al. Long-Term outcomes after stress echocardiography in real world practice: five-year follow-up of the UK Evarest study. Eur. Heart J. Cardiovasc. Imaging 2024;jeae291.
