A positive echocardiogram (ECG) stress test can predict not just cardiovascular mortality but also death due to cancer, a team of Italian researchers reported this week in the Journal of the American Heart Association.
Stress echocardiography (SE) is well-known for is diagnostic and risk stratification benefits in patients with known or suspected coronary artery disease (CAD), first author Clara Carpeggiani, MD, and colleagues wrote in their study, and its efficacy has been proven in predicting both soft endpoints like coronary revascularization and hard ones like myocardial infarction.
Still, despite these prognostic perks, clinicians have been unsure of SE’s ability to predict adverse events unrelated to cardiology.
“From the pathophysiological viewpoint, it is consistent with our current knowledge of ischemic heart disease that SE positivity mirrors the functional impact of underlying CAD, which is the strongest predictor of future cardiovascular events,” Carpeggiani et al. wrote. “With longer follow-up times of expanding cohorts becoming available, now additional, more refined analyses also can be made.”
There is “little apparent rationale” for linking SE results and cancer deaths, the authors wrote, but a growing body of data suggests an increasing number of cardiac patients are eventually dying of cancer. Statistically and biologically, it seems plausible to explore the possible ties between SE readings and a range of other adverse endpoints.
Carpeggiani and colleagues retrospectively analyzed 4,673 patients who’d undergone SE between 1983 and 2009 in a single-center, observational study. All participants were cancer-free at the study’s baseline and were followed-up with for an average of 11 years.
The researchers analyzed separate, predetermined endpoints for the trial, including cardiovascular deaths, cancer deaths and noncardiovascular, noncancer deaths. SE results were negative in the majority of patients—2,916—but positive in 1,757 cases.
Twenty-five year mortality data suggested a significant association between SE positivity and mortality, whereas patients with negative SE results saw fewer deaths in the decades following their exam. Carpeggiani and co-authors also found SE positivity to be a strong predictor of both cancer and cardiovascular mortality, with cancer risk diverging after 15 years. There wasn’t any apparent link between SE results and noncardiovascular, noncancer death.
These results suggest cardiovascular disease and cancer might share risk factors, the authors wrote, especially when it comes to mortality. For patients with stable, low-risk CAD, they said, “it may be advantageous to minimize exposure to known oncogenic risk factors.”
“What we can say from our data is that a negative SE test is associated with a low cardiovascular and cancer risk, which can be a clinically relevant information,” Carpeggiani et al. wrote. “What we cannot say is that we can reassure a cancer patient with negative SE that they will do fine, since a previous history or current evidence of cancer were exclusion criteria in our study.”