Frequency, Predictors, and Implications of Abnormal Blood Pressure Responses During Dobutamine Stress Echocardiography

Abstract

Background It is not known whether abnormal blood pressure (BP) responses during dobutamine stress echocardiography (DSE) are associated with abnormal test results, nor if such results indicate obstructive coronary artery disease (CAD). We sought to define the frequency of abnormal BP responses during DSE and their impact on accuracy of test results. Methods and Results We studied 21,949 patients who underwent DSE at Mayo Clinic, Rochester MN, grouped by peak systolic BP achieved during the test. We also analyzed a subgroup who underwent coronary angiography within 30 days after positive DSE (n=1,126). The positive predictive value (PPV) of DSE was calculated for each BP subgroup. Patients with hypertensive response (n=1,905; 9%) were more likely to have positive DSE than those with normal (n=19,770; 90%) or hypotensive (n=274; 1%) BP responses (32% vs. 21% vs. 23% respectively, p<0.0001). Angiography, preformed in 1,126 patients, showed obstructive CAD (≥50% stenosis) in 814 patients and severe CAD (≥70% stenosis) in 708. PPV of DSE was similar for patients who had hypertensive and normal BP responses (69% vs. 73%, p=0.3), considering 50% stenosis cut-point. The proportion of severe CAD (≥70% stenosis) was lower in patients who had hypertensive response compared to normal BP response (54% vs. 65%, p=0.005). Conclusions Patients with hypertensive response during DSE are more likely to have stress-induced myocardial ischemia compared to those with normal or hypotensive BP responses, but are not more likely to have false positive DSE results. They are, however, less likely to have higher grade or multivessel CAD.

Guidelines for Performance, Interpretation, and Application of Stress Echocardiography in Ischemic Heart Disease: From the American Society of Echocardiography

“…125 Patients with hypertensive responses during DSE were more likely to have stressinduced myocardial ischemia compared to those with normal BP response, but were not more likely to have false-positive DSE results. 126 However, severe CAD is less likely to be present in patients with a hypertensive response during DSE compared to those who have a normal blood pressure response. Hence, it should not be assumed that the development of wall motion abnormalities in the setting of a hypertensive BP response during stress is simply due to the hypertensive BP response itself, or that these positive stress findings signify a falsepositive result.…”

LncRNA SNHG8 is identified as a key regulator of acute myocardial infarction by RNA-seq analysis

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“…According to the latest epidemiological studies, the number of CAD patients will increase rapidly in the next 10 years (Chen et al, 2018 ). As a multifactorial and complex disorder, many genetic complications and environmental exposures, including early family history, unhealthy life habits (such as smoking and excessive drinking), hypertension, dyslipidemia, obesity and diabetes, can result in CAD (Yamada et al, 2015 ; Abram et al, 2017 ; Chiu et al, 2018 ; Madhavan et al, 2018 ). At the same time, improvements in science and technology have provided us with a new understanding of CAD that abnormal gene expression plays an important role in the pathogenesis of CAD (Malakar et al, 2019 ).…”