C  2007, the Authors Journal compilation C  2007, Blackwell Publishing, Inc. DOI: 10.1111/j.1540-8175.2007.00482.x Risk Stratification and Prognosis in Octogenarians Undergoing Stress Echocardiographic Study Farooq A. Chaudhry, M.D., F. A. C. C., Ehtasham A. Qureshi, M.D., Siu-Sun Yao, M.D., F.A.C.C., and Sripal Bangalore, M.D., M. H. A. Department of Medicine, Division of Cardiology, St. Luke’s-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York Background: The prognostic value of stress echocardiography (SE) for the diagnosis and risk strati- fication of coronary artery disease in octogenarians is not well defined. Methods: Follow-up of 5 years (mean 2.9 ± 1.0 years) for confirmed nonfatal myocardial infarction (n = 17) and cardiac death (n = 37) was obtained in 335 patients, age ≥80 years (mean age 84 ± 3 years, 44% male), undergoing SE (33% treadmill, 67% dobutamine). Left ventricular (LV) regional wall motion was assessed by a consensus of two echocardiographers and scored as per standard five-point scale, 16-segment model of wall motion analysis. Ischemic LV wall segment was defined as deterioration in the thickening and excursion during stress (increase in wall-motion score index (WMSI) ≥1). Results: By univariate analysis, inducible ischemia (chi-square = 38.4, P < 0.001), left ventricular ejection fraction (chi- square = 41.2, P < 0.001), a history of previous myocardial infarction (chi-square = 22.3, P < 0.01), hypertension (chi-square = 33, P < 0.01), and age (chi-square = 27.7, P < 0.01) were significant predictors of future cardiac events. WMSI, an index of inducible ischemia, provided incremental prognostic information when forced into a multivariable model where clinical and rest echocardiog- raphy variables were entered first. WMSI effectively stratified octogenarians into low- and high-risk groups (annualized event rates of 1.2versus 5.8%/year, P < 0.001). Conclusions: Stress echocardiog- raphy yields incremental prognostic information in octogenarians and effectively stratifies them into low- and high-risk groups. Precise therapeutic decision making in very elderly patients should incor- porate combined clinical and stress echocardiography data. (ECHOCARDIOGRAPHY, Volume 24, September 2007) octogenarians, prognosis, stress echocardiography Individuals aged ≥65 years constitute 22% of the total population of the United States, of which, people aged ≥85 years are the fastest growing cohort. Additionally, it is estimated that this octogenarian population will com- prise 79 million people by the year 2050. 1 There exists a linear relationship between age and prevalence and severity of coronary artery disease (CAD) with heart disease being the commonest cause of death in the elderly pa- tients. 2,3 The symptoms of myocardial ischemia Address for correspondence and reprint requests: Farooq A. Chaudhry, M.D., F.A.C.C., St. Luke’s-Roosevelt Hos- pital Center, Division of Cardiology, 1111Amsterdam Av- enue, New York, NY 10025. Fax: 212-523-5989; E-mail: fchaudhry@chpnet.org are often atypical in the very elderly pa- tients, furthermore, the limited exercise capac- ity of most octogenarians makes their diagnos- tic evaluation more difficult. 4,5 It is conceivable that these patients would benefit from an ac- curate noninvasive test for the assessment of presence and extent of CAD, where, a nega- tive study will negate unnecessary drug ther- apy and interventions, often less well tolerated by this group. On the other end of the spectrum, an abnormal study may appropriately stratify patients who will benefit from an aggressive treatment plan. Stress echocardiography (SE), an established technique for the diagnosis of CAD, is used with increasing frequency for risk stratifi- cation, prognosis, and patient management Vol. 24, No. 8, 2007 ECHOCARDIOGRAPHY: A Jrnl. of CV Ultrasound & Allied Tech. 851