False-positive exercise echocardiograms: impact of sex and blood pressure response

Various diagnostic methods have been used to evaluate hypertensive patients under physical and pharmacological stress. Several studies have shown that exercise hypertension has an independent, adverse impact on outcome; however, other prognostic studies have shown that exercise hypertension is a favorable prognostic indicator and associated with good outcome. Exercise hypertension may be encountered as a warning signal of hypertension at rest and future hypertensive left ventricular hypertrophy. The results of diagnostic stress tests support that hypertensive response to exercise is frequently associated with high rate-pressure product in hypertensives. In addition to the observations on high rate-pressure product and enhanced ventricular contractility in patients with hypertension, evaluation of myocardial contractility by Doppler tissue imaging has shown hyperdynamic myocardial function under pharmacological stress. These recent quantitative data in hypertensives suggest that hyperdynamic myocardial function and high rate-pressure product response to stress may be related to exaggerated hypertension, which may have more importance than that it has been already given in clinical practice.

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“…Women appear to be susceptible to wall motion abnormalities caused by elevated exercise blood pressure [27]. …”

Section: Introductionmentioning

confidence: 99%

Stress induced hypertensive response: should it be evaluated more carefully?

Küçukler

Yalçın

Abraham

et al. 2011

Cardiovasc Ultrasound

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“…The false positivity for induced ischemia (positive TSE results for a specific coronary artery territory, but without stenosis of that coronary artery on CAG) was relatively high for the right coronary artery and left circumflex artery. Localized basal inferior wall abnormalities, a hypertensive response to exercise and other factors are related to false-positive or false-negative results during stress echocardiography, and patients with these factors should be carefully managed 16-18)…”

Section: Discussionmentioning

confidence: 99%

Treadmill Exercise Stress Echocardiography in Patients With No History of Coronary Artery Disease: A Single-Center Experience in Korean Population

et al. 2011

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Background and ObjectivesTreadmill exercise stress echocardiography (TSE) has superior diagnostic accuracy than exercise electrocardiography (ECG). The objectives of the study are 1) to define the diagnostic accuracy and safety of TSE in patients without a history of coronary artery disease (CAD), 2) to identify the clinical characteristics that predict positive TSE results and 3) to assess the differential predictive value between TSE and concomitant exercise ECG in a Korean population.Subjects and MethodsA total of 1,287 patients among 1,500 consecutive patients with no prior history of CAD and who were referred for TSE during a 4-year 3-month period were enrolled.ResultsOf the 1,287 patients, 95 (7.4%) showed positive TSE results (newly developed regional wall motion abnormality). Among the 154 patients with coronary angiography, 94 patients (61%) showed significant CAD (30 of 77 patients with negative TSE results and 64 of 77 patients with positive TSE results). The TSE positive population had more cardiovascular risk factors and showed a higher Duke treadmill score and wall motion score index than the TSE negative group. TSE showed relatively good sensitivity (68%), specificity (78%) and positive and negative predictive values (83% and 61%, respectively), and TSE also had higher diagnostic accuracy than concomitant exercise ECG (72% vs. 64%, respectively).ConclusionTSE is safe and offers greater diagnostic power for CAD than exercise ECG in Korean population without a history of CAD. Its prognostic value in this population needs to be confirmed in a larger prospective study.

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“…Se ha propuesto que una respuesta exagerada de la presió n arterial al ejercicio es la causa principal de las anomalías de la funció n ventricular izquierda en ausencia de EAC 19,20 . En cambio, un estudio reciente no observó que un aumento notable de la presió n arterial sistó lica se asociara a un resultado anormal en la ecocardiografía de ejercicio 21 .…”

Section: Mecanismos De La Disfunció N Ventricular Izquierda Inducida unclassified

Valor pronóstico de la disfunción ventricular izquierda inducida por el ejercicio en pacientes hipertensos sin enfermedad arterial coronaria

Prada-Delgado

Barge‐Caballero

Peteiro

et al. 2015

Revista Española de Cardiología

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False-positive exercise echocardiograms: impact of sex and blood pressure response

Cited by 21 publications

References 18 publications

Stress induced hypertensive response: should it be evaluated more carefully?

Stress induced hypertensive response: should it be evaluated more carefully?

Treadmill Exercise Stress Echocardiography in Patients With No History of Coronary Artery Disease: A Single-Center Experience in Korean Population

Valor pronóstico de la disfunción ventricular izquierda inducida por el ejercicio en pacientes hipertensos sin enfermedad arterial coronaria

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