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Original research article
Simple six-item clinical score improves risk prediction capability of stress echocardiography
  1. Lauro Cortigiani1,
  2. Clara Carpeggiani2,
  3. Rosa Sicari2,
  4. Claudio Michelassi2,
  5. Francesco Bovenzi1,
  6. Eugenio Picano2
  1. 1 Division of Cardiology, San Luca Hospital, Lucca, Italy
  2. 2 CNR, Department of Biomedical Sciences, Institute of Clinical Physiology, Pisa, Italy
  1. Correspondence to Dr Clara Carpeggiani, CNR, Department of Biomedical Sciences, Institute of Clinical Physiology, Pisa 56124, Italy; clara{at}


Objectives To assess the value of a simple score integrating non-ischaemia-related variables in expanding the wall motion abnormalities risk power during stress echocardiography (SE).

Methods Study includes 14 279 patients who underwent SE for evaluation of coronary artery disease. All-cause death was the end point. Patients were randomly divided into the modelling and validation group of equal size. In the modelling group, multivariate analysis was conducted using clinical, rest and SE data, and a score was obtained from the number of non-ischaemia-related independent prognostic predictors. The score prognostic capability was compared in both groups.

Results During a median follow-up of 31 months, 1230 patients died: 622 (9%) in the modelling and 608 (9%) in the validation group (p=0.68). Independent predictors of mortality were ischaemia at SE (HR 1.77, 95% CI 1.49 to 2.12; p<0.0001) and six other parameters: age>65 years, wall motion at rest, diabetes, left bundle branch block, anti-ischaemic therapy and male sex. Risk score resulted prognostically effective in the modelling and validation groups, both with and without inducible ischaemia subset. When risk score was included in the multivariate analysis, besides ischaemia at SE it was the only independent predictor of mortality in the modelling (HR 1.70, 95% CI 1.60 to 1.82; p<0.0001), in the validation (HR 1.77, 95% CI 1.65 to 1.90; p<0.0001) and in the overall group (HR 1.73, 95% CI 1.66 to 1.82; p<0.0001).

Conclusions Simple clinical variables may be able to optimise SE risk stratification.

  • echocardiography
  • chronic coronary disease
  • epidemiology
  • quality and outcomes of care

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  • Contributors LC: data collection, data analysis and wrote manuscript. CC: data analysis, contributed to study design and discussion for critically important content. RS: data collection, contributed to discussion and edited manuscript CM: revised statistical analysis for critically important content. FB: contributed to discussion. EP: original idea, data collection, oriented data analysis, wrote and edited manuscript.

  • Funding This study was funded by National Research Council of Italy.

  • Disclaimer LC and CC have full access to all the data of the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Institutional review boards of all centres participating in the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.