Long-term prognosis and predictors of outcomes after negative stress echocardiography

Rachwan, Rayan Jo; Mshelbwala, Fakilahyel S.; Chaaya, Rody G. Bou; El-Am, Edward; Sabra, Mohammad; Dardari, Zeina; Jaradat, Z.; Batal, Omar

doi:10.1007/s10554-020-01913-6

Cited by 3 publications

(1 citation statement)

References 31 publications

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“…Dobutamine stress echocardiography (DSE) is a commonly utilized and well-validated procedure for the evaluation of ischemia and suspected coronary artery disease (CAD) ( 1 ). This modality has been shown to have a high accuracy (80–90%) in detecting obstructive CAD (>50% stenosis) and good prognostic value following a negative result, with a low risk of overall mortality in the absence of wall motion abnormalities (WMAs) with stress testing ( 2 ).…”

Section: Introductionmentioning

confidence: 99%

Association of abnormal electrocardiography response on dobutamine stress echocardiogram with longer-term major adverse cardiovascular events in women with symptoms of ischemic heart disease

Ranasinghe,

Tjoe,

Shufelt

et al. 2023

Cardiovasc Diagn Ther

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Background Prior work demonstrates patients with positive (+) electrocardiogram (ECG) but negative (−) echocardiogram wall motion abnormalities (WMAs) on dobutamine stress echocardiography (DSE) testing have an elevated of major adverse cardiovascular events (MACEs). In this study, we aimed to evaluate the long-term prognosis of women with suspected ischemia with no obstructive coronary artery (INOCA) disease by utilizing core lab read DSE, specifically focusing on those with + ECG findings. Methods Among women with signs and symptoms of myocardial ischemia undergoing clinically indicated coronary angiography enrolled in the Women’s Ischemia Syndrome Evaluation (WISE) [1997–2001], a prospective cohort study, 99 underwent standardized DSE by site design. Women with positive DSE (n=17), defined as an increase in score based on wall motion scoring index were excluded except for akinetic to dyskinetic (n=10), providing 82 patients in this analysis. ECG was assessed by core laboratory and (+) ECG was defined as >1 mm ST change. Non-obstructive coronary artery disease (CAD) was assessed by core laboratory quantitative coronary angiography and defined as <50% epicardial stenosis. All-cause death follow-up was an average of 8 years, while adjudicated MACE [all-cause mortality, nonfatal myocardial infarction (MI), nonfatal stroke, heart failure hospitalization] was an average of 5.5 years. Comparisons among subject groups [i.e., (+) ECG and (–) ECG] were made using chi-square or Fisher’s exact tests for categorical variables and t -test or Wilcoxon rank-sum test for continuous variables. Results Demographic profile included a mean age 59±10 years; 55% had hypertension (HTN), 29% diabetes mellitus (DM), and 72% non-obstructive CAD. Overall, 9/82 women (11%) had (+) ECG in the absence of WMAs. There were significant differences in family history of CAD (P=0.009) and vasodilator (P=0.042) use between the (+) ECG and (−) ECG groups, but otherwise had no significant demographic or clinical differences. At longer-term follow up, patients with (+) ECG had higher risk of MACE [unadjusted hazard ratio (HR): 4.91, 95% confidence interval (CI): 1.83, 13.19, P=0.002]. Conclusions Abnormal stress ECG findings on dobutamine stress testing with a negative DSE should be viewed as an indicator of longer-term risk in women with signs and symptoms of ischemia.

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Section: Introductionmentioning

confidence: 99%