Female False Positive Exercise Stress ECG Testing – Fact Versus Fiction

Fitzgerald, B.; Scalia, W.; Scalia, G.

doi:10.1016/j.hlc.2018.02.010

Cited by 18 publications

(22 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This does reflect real world experiences and this particular study population. 18,42,43 The investigators were not blinded to the results of the stress test, making it possible for biases (including ascertainment bias) to occur. Overall event rates were low, especially in the non-ischemic patients.…”

Section: Discussionmentioning

confidence: 99%

The prognostic value of estimating stroke volume before and after exercise during treadmill stress echocardiography

Fitzgerald

Logan

Weldon

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Stress echocardiography (SE) is an established technique for assessment of coronary artery disease (CAD) which is difficult to perform and interpret. Left ventricular stroke volume (SV) is readily estimated with Doppler echocardiography. It can be affected by myocardial ischemia, with possible adjunctive value during SE. Methods: Patients underwent Bruce protocol SE with SV estimated before and after maximal treadmill exertion post routine regional wall analysis. Incremental change in SV (ΔSV) with exercise was measured. Results: A derivation cohort (n=273) was established to test the hypothesis. An optimal cutoff for detection on inducible ischemia was ΔSV [?] +10ml. The validation cohort of consecutive patients (n = 1093, 376 [34%] female; age 59±12 years) were followed clinically after SE for 20,460 patient-months. There were 1000 patients with non-ischemic SE, and 93 patients with studies suggestive of myocardial ischemia. Secondary analysis yielded 831 patients with a normal exercise response (ΔSV > +10ml) and 192 with an abnormal ΔSV [?] +10ml. Time to first combined adverse cardiac event (composite of angina, acute coronary syndrome, cardiac revascularization, worsening New York Heart Association (NYHA) class, a reduction in EF, and cardiovascular death) was analysed and adjusted using Cox proportional hazards regression. The hazard ratio for an adverse event with an abnormal ΔSV response ([?]10ml) was 10.3 (95% confidence intervals 5.6-19.1, p<0.0001). Conclusions: SV assessment during SE is feasible and readily performed. It is simple, practical and has incremental diagnostic and prognostic value when added to exercise regional wall motion analysis.

show abstract

Section: Discussionmentioning

confidence: 99%

The prognostic value of estimating stroke volume before and after exercise during treadmill stress echocardiography

Fitzgerald

Logan

Weldon

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…A study done in Bangladesh concluded that the ETT was more sensitive for males, while the females were prone to have false-positive results in this regard [12]. Furthermore, another study reports that females have a greater risk of false-positive ETT, which has led to the use of more invasive radiological modalities (magnetic resonance imaging or radioactive scans) for initial evaluation of CAD [14,15]. Pertinently, women have a higher predisposition toward falsepositive results, and they should be investigated and managed with caution, and further evaluation should be considered [15].…”

Section: Discussionmentioning

confidence: 99%

Gauging the Positive Predictive Value of Exercise Tolerance Test Using Angiographic Evaluation: A Cross-Sectional Analysis From a Developing Country

Khan¹,

Hasan²,

Hasan³

et al. 2020

Cureus

View full text Add to dashboard Cite

“…There were significantly less women than men (a common problem in cardiac research). This does reflect real‐world experiences and this particular study population 18,50,51 . The investigators were not blinded to the results of the stress test, making it possible for biases (including ascertainment bias) to occur.…”

Section: Discussionmentioning

confidence: 99%

“…To have completed this analysis with complete data rather than imputation of missing values may not have been associated in an epidemiological context with substantial bias in reported regression estimates. 15,49 The multivariable prediction model described in the present study was derived from echocardiographic observations at a single center. There were significantly less women than men (a common problem in cardiac research).…”

Section: F I G U R Ementioning

confidence: 99%

The prognostic value of estimating stroke volume before and after exercise during treadmill stress echocardiography

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background Stress echocardiography (SE) is an established technique for assessment of coronary artery disease (CAD) which is difficult to perform and interpret. Left ventricular stroke volume (SV) is readily estimated with Doppler echocardiography. It can be affected by myocardial ischemia, with possible adjunctive value during SE. Methods Patients underwent Bruce protocol SE with SV estimated before and after maximal treadmill exertion post routine regional wall analysis. Incremental change in SV (ΔSV) with exercise was measured. Results A derivation cohort (n = 273) was established to test the hypothesis. An optimal cutoff for detection on inducible ischemia was ΔSV ≤ +10 mL. The validation cohort of consecutive patients (n = 1093, 376 [34%] female; age 59 ± 12 years) were followed clinically after SE for 20 460 patient‐months. There were 1000 patients with nonischemic SE, and 93 patients with studies suggestive of myocardial ischemia. Secondary analysis yielded 831 patients with a normal exercise response (ΔSV > +10 mL) and 192 with an abnormal ΔSV ≤ +10 mL. Time to first combined adverse cardiac event (composite of angina, acute coronary syndrome, cardiac revascularization, worsening New York Heart Association (NYHA) class, a reduction in EF, and cardiovascular death) was analyzed and adjusted using Cox proportional hazards regression. The hazard ratio for an adverse event with an abnormal ΔSV response (≤10 mL) was 10.3 (95% confidence intervals 5.6‐19.1, P < .0001). Conclusions Stroke volume assessment during SE is feasible and readily performed. It is simple, practical, and has incremental diagnostic and prognostic value when added to exercise regional wall‐motion analysis.

show abstract

Female False Positive Exercise Stress ECG Testing – Fact Versus Fiction

Cited by 18 publications

References 27 publications

The prognostic value of estimating stroke volume before and after exercise during treadmill stress echocardiography

The prognostic value of estimating stroke volume before and after exercise during treadmill stress echocardiography

Gauging the Positive Predictive Value of Exercise Tolerance Test Using Angiographic Evaluation: A Cross-Sectional Analysis From a Developing Country

The prognostic value of estimating stroke volume before and after exercise during treadmill stress echocardiography

Contact Info

Product

Resources

About