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False-positive exercise echocardiograms: impact of sex and blood pressure response
Joon-Han Shin1, Takahiro Shiota, Yong-Jin Kim
1Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Insights
Female sex, higher peak exercise blood pressure (BP), and lower Duke score predict false-positive exercise echocardiograms (ExE) for coronary disease. Women are more susceptible to exercise-induced wall motion abnormalities. Consider these factors in ExE interpretation.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Clinical Medicine
Background:
- Factors contributing to false-positive results in exercise echocardiography (ExE) for diagnosing coronary artery disease (CAD) require further investigation.
- Previous studies predated the widespread adoption of digital and tissue harmonic imaging, necessitating updated research.
- This study aimed to identify clinical and echocardiographic predictors of false-positive ExE results.
Purpose of the Study:
- To evaluate clinical and echocardiographic predictors of false-positive exercise echocardiography (ExE) results.
- To identify patient characteristics associated with inaccurate ExE diagnoses of coronary artery disease.
- To inform the interpretation of ExE by highlighting factors that may lead to false-positive outcomes.
Main Methods:
- Retrospective analysis of 464 patients who underwent both coronary angiography and ExE.
- Definition of significant coronary artery disease as stenoses > or =50% lumen diameter.
- Analysis of clinical (sex, blood pressure) and echocardiographic (wall motion score index, Duke score) variables.
Main Results:
- False-positive ExE results were observed in 13% of patients (58/464).
- Women constituted a significantly higher proportion of the false-positive group (53%) compared to the true-positive group (25%).
- Higher peak systolic blood pressure (BP), lower Duke-predicted risk, and lower post-exercise wall motion score index (WMSI) were associated with false-positive results. Specificity decreased at higher BP levels, particularly in women at >=180 mm Hg and men at >=200 mm Hg.
Conclusions:
- Predictive factors for false-positive ExE in diagnosing coronary disease include female sex, elevated peak exercise BP, lower Duke risk score, and lower post-exercise WMSI.
- Women may be more prone to exercise-induced wall motion abnormalities due to elevated exercise BP.
- These identified variables are crucial considerations for accurate interpretation of ExE findings.
Background:
Factors related to false-positive results of exercise echocardiography (ExE) to diagnose coronary disease have not been extensively studied. In addition, previous studies were performed before routine use of digital and tissue harmonic imaging. We evaluated the clinical and echocardiographic predictors of false-positive results during ExE.
Methods:
Four hundred sixty-four patients who had both coronary angiography and ExE were enrolled retrospectively. Significant coronary disease was defined by stenoses > or =50% lumen diameter.
Results:
Fifty-eight (13%) had false-positive results. Thirty-one (53%) of these patients were women, which was significantly higher than the percentage of women (25%) in the true-positive group (P <.001). Average peak systolic blood pressure (BP) in the false-positive group was significantly higher than in the true-positive group. Test specificity was decreased at higher levels of BP without change of sensitivity. Men demonstrated a decrease in specificity at peak systolic BP > or =200 mm Hg, whereas women showed a sharp decrease in specificity at BP > or =180 mm Hg. Wall motion score index (WMSI) after peak exercise and the proportion of high- and intermediate-risk patients according to Duke score were significantly lower in the false-positive than in the true-positive group.
Conclusions:
The factors predictive of false-positive results during ExE to diagnose coronary disease were female sex, higher BP at peak exercise, lower risk by Duke score and lower number of abnormal segments and wall motion score index after peak exercise. Women appear to be susceptible to wall motion abnormalities caused by elevated exercise BP. These variables should be considered in the interpretation of ExE.
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