CONGRESS ABSTRACT

Exercise echocardiography is a non-invasive, radiation-free, and cost-effective diagnostic tool for detecting inducible ischemia, with high sensitivity and specificity. Aim of this study was to evaluate its utility in the emergency department (ED) for ruling out angina. The retrospective observational study involved patients presenting to the ED between March 2022 and November 2024 with suspected angina, who according to local protocol underwent exercise echocardiography following negative results from other tests (rest ECG, echocardiogram, and cardiac biomarkers). The study analyzed the correlation between echocardiographic findings and subsequent revascularization or adverse cardiac events requiring hospitalization within a 6-month follow-up. A total of 610 patients underwent exercise echocardiography, with a 30W/90-second supine bike protocol in the majority of cases. Of these, 48 patients had a positive test (mean heart rate 78±9% of maximal), leading to hospitalization and coronary angiography. Most were male (75%), with a mean age of 69±10 years, and 29% had a history of coronary artery disease (CAD). Among them, 41 patients were diagnosed with significant CAD, and 96% underwent revascularization (91% percutaneous, 5% surgical). Only 12 out of 562 patients with negative tests required hospitalization within six months. Eight had coronary angiograms, but only two required revascularization, while five experienced arrhythmias. In conclusion, exercise echocardiography demonstrated an 86% positive predictive value for significant CAD and an excellent 99.5% negative predictive value for the need for coronary revascularization within six months, providing valuable decision-making insights in the ED; it showed a potential to improve diagnostic accuracy and optimize resource allocation.