Related Experiment Videos
Hemodynamic characteristics of patients with coronary artery disease presenting false-negative exercise stress test
M Sekiya1, M Suzuki, Y Fujiwara
1Second Department of Internal Medicine, Ehime University School of Medicine, Japan.
Insights
The Master's two-step stress test shows a high rate of false-negative results in coronary artery disease patients with left ventricular dysfunction. Careful interpretation is needed for these patients.
Area of Science:
- Cardiology
- Diagnostic Testing
- Clinical Research
Background:
- The Master's two-step stress test is a common diagnostic tool for coronary artery disease (CAD).
- False-negative results can lead to delayed diagnosis and treatment of CAD.
- Understanding factors contributing to false-negative responses is crucial for accurate patient management.
Purpose of the Study:
- To investigate the left ventricular (LV) hemodynamics and coronary artery characteristics in patients with CAD who exhibit a false-negative Master's two-step stress test.
- To determine the prevalence of false-negative responses in this patient population.
Main Methods:
- Eighty-eight consecutive patients with suspected or known CAD underwent the Master's two-step stress test.
- Coronary angiography was performed for all patients.
- Left ventricular hemodynamics were assessed, including end-diastolic pressure, ejection fraction, and cardiac output.
Main Results:
- The Master's two-step stress test yielded a false-negative response in 20% of patients.
- Patients with false-negative responses showed elevated left ventricular end-diastolic pressure, reduced ejection fraction, and low cardiac output compared to true-positive responders.
- The extent of CAD and prior myocardial infarction did not influence the false-negative rate.
Conclusions:
- False-negative results on the Master's two-step stress test are frequent in CAD patients with significant left ventricular dysfunction.
- Clinical judgment of the Master's two-step test results requires caution in symptomatic individuals with severe LV impairment.
Abstract:
The present study was designed to clarify the characteristics of left ventricular hemodynamics and coronary arteries in patients with coronary artery disease presenting false-negative response to the Master's two-step stress test. Eighty-eight consecutive patients performed the Master's two-step stress test and had coronary angiography for evaluation of suspected or known coronary artery disease. The frequency of false-negative and true-positive responses in the Master's two-step stress test was 20% and 45%, respectively. Elevated left ventricular end-diastolic pressure, reduced ejection fraction, and low cardiac output characterized the left ventricular hemodynamics in patients with false-negative responses, as compared with those with true-positive response. The severity and extent of coronary artery disease, as well as prior myocardial infarction, did not affect the frequency of false-negative response. This study indicates that the false-negative response to the Master's two-step test is unexpectedly frequent in coronary artery disease with severe left ventricular dysfunction. Thus, one should be careful in judging the results of the Master's two-step test in symptomatic patients with severe left ventricular dysfunction.