Prognostic significance of ischaemic electrocardiographic changes during stress testing in patients with normal
Ghufran Adnan1, Fateh Ali Tipoo Sultan2, Umaira Alauddin3
1Department of Cardiology, Aga Khan University Hospital, Karachi.
Insights
Patients with normal myocardial perfusion scans but ischemic electrocardiogram changes during stress tests had a low risk of cardiovascular events. These findings suggest that such results do not necessarily indicate adverse outcomes.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Clinical Medicine
Background:
- Nuclear myocardial perfusion imaging (MPI) is a key diagnostic tool.
- Ischemic electrocardiogram (ECG) changes during stress tests can indicate coronary artery disease.
- The significance of ischemic ECG changes with normal MPI is not fully understood.
Purpose of the Study:
- To evaluate cardiovascular outcomes in patients with normal MPI but ischemic ECG changes during stress tests.
- To determine the risk of adverse cardiac events in this specific patient group.
Main Methods:
- Retrospective study of patients undergoing pharmacological or exercise stress MPI between January 2013 and December 2014.
- Inclusion criteria: normal MPI with ischemic ECG changes during stress.
- Data collection included cardiac events (angina, myocardial infarction, heart failure, revascularization, cardiac death) and non-cardiac deaths.
Main Results:
- 296 (10.6%) of 2770 patients met the inclusion criteria (normal MPI, ischemic ECG changes).
- Mean age was 62±15 years; 61% were male.
- Over a mean follow-up of 48±7 months, 8 (2.8%) patients died, 2 (0.7%) had myocardial infarction, 1 (0.3%) experienced heart failure, and 12 (4.3%) underwent revascularization.
Conclusions:
- Ischemic ECG changes during stress testing in patients with normal MPI are not associated with adverse cardiovascular outcomes.
- The risk of major cardiovascular events is relatively low in this population over an intermediate follow-up period.
Objective:
To evaluate cardiovascular outcomes in patients with normal nuclear myocardial perfusion imaging, but ischaemic electrocardiogram changes during pharmacological or exercise stress tests.
Methods:
The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data of patients who underwent either pharmacological or exercise stress myocardial perfusion scan and had a normal scan with ischaemic electrocardiogram changes between January 2013 and December 2014. All cardiac events, including angina, myocardial infarction, heart failure, coronary revascularisation and cardiac death, as well as non-cardiac deaths were noted. Data was analysed using STATA 14.2.
Results:
Of the 2770 patients whose data was initially checked, 296(10.6%) developed ischaemic electrocardiogram changes during the stress test but had normal myocardial perfusion scan. Of them, 181(61%) patients were male, and the overall mean age was 62±15 years. Follow-up data was available for 280(94.5%) of these patients, with a mean follow-up of 48±7 months. Of these patients, 8(2.8%) died, and 1(0.3%) of them died due to inferior wall myocardial infarction. Myocardial infarction was found in 2(0.7%) patients, and 1(0.3%) patient was hospitalised with heart failure. Also, 12(4.3%) patients underwent revascularization for stable angina, 9(3.2%) underwent percutaneous transluminal coronary angioplasty, and 3(1.07%) needed coronary artery bypass grafting.
Conclusions:
Ischaemic electrocardiographic changes during stress testing in patients with normal myocardial perfusion scan were not associated with adverse outcomes, and the risk of cardiovascular events was relatively low for an intermediate follow-up period.
More Related Videos
09:23Confirmation of Myocardial Ischemia and Reperfusion Injury in Mice Using Surface Pad Electrocardiography
Published on: November 24, 2016
10:21Evaluation of Hydration Status by Bioelectrical Impedance Vector Analysis in Patients with Ischemic Heart Disease Undergoing Exercise Stress Test
Published on: September 22, 2023
Related Concept Videos
01:26Exercise Stress Test
Exercise stress testing, commonly known as a treadmill test, is a noninvasive procedure used to evaluate cardiovascular function and diagnose heart conditions.
Definition
An exercise stress test measures the heart's response to exertion using a treadmill or stationary bicycle. Chest electrodes record the heart's electrical activity through an ECG, and blood pressure is monitored regularly.
Purposes
01:29Electrocardiogram
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and...
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:29Angina III: Clinical Manifestations and Assessment