Long-term survival of patients with chest pain syndrome and angiographically normal or near normal coronary arteries : the additional prognostic value of dipyridamole echocardiogrphy test (DET)

Aims Patients with normal coronary arteries have a heterogeneous prognosis. Aim of this study was to assess whether dipyridamole stress echocardiography positivity identifies a prognostically less benign subset. Methods and results We selected 457 patients (245 males; 56+10 years) who underwent stress highdose dipyridamole echocardiography and had angiographically non-significant (,50% visually assessed) stenosis in any major vessel and preserved left ventricular function. All patients were followed up for a median of 7.1 years (first quartile 5 and third quartile 10.5). Dipyridamole echocardiography test (DET) positivity for regional dysfunction occurred in 43(9%) patients. Kaplan-Meier survival estimates showed a significant better outcome for those patients with negative dipyridamole echocardiography test compared with those with a positive test (90 vs. 75.7%, at 140 months of follow-up, P ¼ 0.0018). At multivariable analysis, mild or moderate irregularity on coronary arteriogram (HR ¼ 3.3, CI 95% ¼ 1.7-6.2), diabetes (HR ¼ 3.5, CI 95% ¼ 1.4-9.2), and wall motion score index at peak stress (HR ¼ 6.7, CI 95% ¼ 2.5-17.8) were independent predictors of all-cause death. Conclusion DET adds incremental value to the prognostic stratification achieved with clinical and angiographic data in the subset of patients with normal or near-normal coronary arteries.