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Frequency, Predictors, and Implications of Abnormal Blood Pressure Responses During Dobutamine Stress
Sara Abram1, Adelaide M Arruda-Olson1, Christopher G Scott1
1From the Department of Cardiovascular Diseases (S.A., A.M.A.-O., P.A.P., V.T.N., J.K.O., M.M.A., R.B.M.) and Division of Biomedical Statistics and Informatics (C.G.S.), Mayo Clinic, Rochester, MN; and Department of Medical Sciences, University of Torino, Turin, Italy (S.A., A.M.).
Insights
Hypertensive blood pressure responses during dobutamine stress echocardiography (DSE) indicate higher rates of stress-induced myocardial ischemia. However, these responses do not increase false-positive DSE results and are linked to less severe coronary artery disease (CAD).
Area of Science:
- Cardiology
- Diagnostic Imaging
- Clinical Medicine
Background:
- The association between abnormal blood pressure (BP) responses during dobutamine stress echocardiography (DSE) and test accuracy for obstructive coronary artery disease (CAD) remains unclear.
- Investigating the frequency and impact of abnormal BP responses during DSE is crucial for understanding its diagnostic utility.
Purpose of the Study:
- To determine the frequency of abnormal BP responses during DSE.
- To assess the impact of these BP responses on the accuracy of DSE results for detecting obstructive CAD.
Main Methods:
- A retrospective analysis of 21,949 patients who underwent DSE.
- Patients were categorized by peak systolic BP response (hypertensive, normal, hypotensive).
- Coronary angiography was performed in a subgroup to validate DSE findings and assess CAD severity.
Main Results:
- Patients with a hypertensive BP response (9%) were more likely to have a positive DSE compared to normal or hypotensive responses (32% vs. 21-23%).
- The positive predictive value of DSE for obstructive CAD (≥50% stenosis) was similar between hypertensive and normal BP response groups (69% vs. 73%).
- Patients with hypertensive BP response showed a lower proportion of severe CAD (≥70% stenosis) compared to the normal BP response group (54% vs. 65%).
Conclusions:
- Hypertensive BP response during DSE is associated with increased likelihood of stress-induced myocardial ischemia.
- Abnormal hypertensive BP responses do not lead to a higher likelihood of false-positive DSE results.
- Patients with hypertensive BP response are less likely to have higher-grade or multivessel coronary artery disease.
Background:
It is not known whether abnormal blood pressure (BP) responses during dobutamine stress echocardiography (DSE) are associated with abnormal test results, nor if such results indicate obstructive coronary artery disease (CAD). We sought to define the frequency of abnormal BP responses during DSE and their impact on accuracy of test results.
Methods And Results:
We studied 21 949 patients who underwent DSE at Mayo Clinic, Rochester, MN, grouped by peak systolic BP achieved during the test. We also analyzed a subgroup who underwent coronary angiography within 30 days after positive DSE. The positive predictive value of DSE was calculated for each BP group. Patients with hypertensive response (n=1905; 9%) were more likely to have positive DSE than those with normal (n=19 770; 90%) or hypotensive (n=274; 1%) BP responses (32% versus 21% versus 23%, respectively; P<0.0001). Angiography, performed in 1126 patients, showed obstructive CAD (≥50% stenosis) in 814 patients and severe CAD (≥70% stenosis) in 708 patients. Positive predictive value of DSE was similar for patients who had hypertensive and normal BP responses (69% versus 73%; P=0.3), considering 50% stenosis cut point. The proportion of severe CAD (≥70% stenosis) was lower in patients who had hypertensive response compared with those who had normal BP response (54% versus 65%; P=0.005).
Conclusions:
Patients with hypertensive response during DSE are more likely to have stress-induced myocardial ischemia compared with those with normal or hypotensive BP responses but are not more likely to have false-positive DSE results. They are, however, less likely to have higher grade or multivessel CAD.
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