False‐positive stress testing: Does endothelial vascular dysfunction contribute to ST‐segment depression in women? A pilot study

Sk, Sharma; Mehta, Puja K.; Arsanjani, Reza; Sedlak, Tara; Hobel, Zachary; Shufelt, Chrisandra; Jones, Erika; Kligfield, Paul; Mortara, David; Laks, Michael M.; Diniz, Márcio A.; Merz, C. Noel Bairey

doi:10.1002/clc.23000

Cited by 7 publications

(4 citation statements)

References 30 publications

(59 reference statements)

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“…In many circumstances, due to the relatively higher prevalence of false-positive traits in women, those with ST-segment depression generally receive non-cardiac diagnoses, with no additional exams or subsequent cardiac treatment. 276 …”

Section: Athlete's Heart Syndrome In Womenmentioning

confidence: 99%

The Brazilian Society of Cardiology and Brazilian Society of Exercise and Sports Medicine Updated Guidelines for Sports and Exercise Cardiology - 2019

Ghorayeb¹,

Stein²,

Daher³

et al. 2019

Arquivos Brasileiros De Cardiologia

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Section: Athlete's Heart Syndrome In Womenmentioning

confidence: 99%

The Brazilian Society of Cardiology and Brazilian Society of Exercise and Sports Medicine Updated Guidelines for Sports and Exercise Cardiology - 2019

Ghorayeb¹,

Stein²,

Daher³

et al. 2019

Arquivos Brasileiros De Cardiologia

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“…Several previous studies showed that increased arterial stiffness is linked to endothelial dysfunction [17] in patients with CAD risk factors [18][19][20]. Although the aortic and peripheral arterial stiffness do not directly affect cardiac electrophysiology, they could affect LV diastolic function during aerobic exercise through ventricular-vascular interaction [21,22].…”

Section: Arterial Stiffness and Exercise-induced St Depressionmentioning

confidence: 99%

Arterial Stiffness is Associated with False-Positive ST-Segment Depression in Supine Bicycle Exercise Stress Echocardiography

Chung¹,

Seo²,

Kim³

et al. 2023

Rev. Cardiovasc. Med.

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Background: Although exercise stress electrocardiography (ECG) is a popular tool for detecting coronary artery disease (CAD), the induced ST-depression without coronary artery stenosis (FST) remains a challenge for accurate diagnosis. Exercise-induced ST depression is related to poor prognosis even in non-obstructive disease; however, its determinants have not been fully defined. We sought to investigate whether ventriculo-vascular interactional indexes such as arterial stiffness index, exercise hemodynamic parameters and echocardiographic left ventricular (LV) functional parameters were related to FST. Methods: In the current study, 609 participants who underwent both supine bicycle exercise echocardiography and brachial-ankle pulse wave velocity (baPWV) measurement without exercise-induced regional wall motion abnormalities (RWMA) were analyzed. Referral reasons for stress test were CAD detection or evaluation of patency of previous revascularization. Stepwise graded supine bicycle exercise was performed with simultaneous ECG recording and echocardiography after full conventional resting echocardiography. The FST was defined as newly developed >1 mm ST depression without RWMA during exercise. Results: The median age of the study participants was 65 (59.0-70.5) years, and 222 (37%) patients were women. Among them, 103 (17%) patients showed FST during the exercise or recovery phase. The prevalence of FST did not differ between sexes. Older age, higher pulmonary arterial systolic pressure (PASP), left atrial volume index, baPWV and ankle brachial index at rest and hypertensive response, higher heart rate and rate-pressure product at peak exercise were significantly associated with FST. In multivariate analysis, higher peak heart rate, PASP, and baPWV were independently related to FST. Conclusions: Stress-induced RWMA in addition to ECG should be evaluated to detect CAD in patients with higher baPWV and PASP. FST might be linked to subclinical myocardial ischemia through arterial stiffness and diastolic dysfunction.

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“…In fact, functional causes of ischemia such as CMD or VSA could often be associated with atypical angina. [17][18][19] The recent results of the Percutaneous Coronary Intervention in Stable Angina (ORBITA) trial suggested that there may be a discordance between cardiac symptoms and ischemia assessed by DSE and invasive physiology, suggesting that symptomatology is complex, multifactorial, and likely to be influenced by more than just significant epicardial coronary disease and myocardial ischemia. 20,21 This may play an important role in patients with INOCA.…”

Section: The Accuracy Of Noninvasive Tests and Symptomsmentioning

confidence: 99%

Gender-Related Differences in Clinical Presentation and Angiographic Findings in Patients with Ischemia and No Obstructive Coronary Artery Disease (INOCA): A Single-Center Observational Registry

et al. 2020

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Ischemia and no obstructive coronary arteries (INOCA) is a common clinical presentation, with a variety of causes that are often not fully investigated in routine clinical practice. The goal of our study was to characterize a real-world population of patients with INOCA, with a deeper focus on symptoms and stress test findings. The study population consisted of 435 patients who underwent diagnostic coronary angiography for anginal symptoms and/or evidence of myocardial ischemia at non-invasive imaging. In all patients angiography demonstrated nonobstructive coronary artery disease (CAD, less than 30% luminal diameter stenosis or fractional flow reserve > 0.8 and/or instantaneous wave-free ratio > 0.89). Fifty-four percent of the patients were women. Atypical clinical presentation was more common in women (59.5 vs. 49.5%, p = 0.037). Women were more likely to have normal coronary arteries than men (41.8 vs. 16.2%, p < 0.001), and less likely than men to have hemodynamically non-significant CAD (32.1 vs. 55.1%, p < 0.001). No significant correlation between typicality of symptoms and evidence of ischemia was found in those patients (244/435, 56.1%) who had either dobutamine stress echocardiography or electrocardiogram stress test. INOCA is a common clinical condition, prevalent in women often presenting with atypical symptoms.

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False‐positive stress testing: Does endothelial vascular dysfunction contribute to ST‐segment depression in women? A pilot study

Cited by 7 publications

References 30 publications

The Brazilian Society of Cardiology and Brazilian Society of Exercise and Sports Medicine Updated Guidelines for Sports and Exercise Cardiology - 2019

The Brazilian Society of Cardiology and Brazilian Society of Exercise and Sports Medicine Updated Guidelines for Sports and Exercise Cardiology - 2019

Arterial Stiffness is Associated with False-Positive ST-Segment Depression in Supine Bicycle Exercise Stress Echocardiography

Gender-Related Differences in Clinical Presentation and Angiographic Findings in Patients with Ischemia and No Obstructive Coronary Artery Disease (INOCA): A Single-Center Observational Registry

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