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Predictors of Obstructive Coronary Artery Disease in Positive Electrocardiogram, Negative Echocardiogram Stress
Andrew Dind1, Daniel McGhie2, Daniel McIntyre1
1Department of Cardiology, Prince of Wales Hospital, Randwick, NSW, Australia; School of Medicine, University of New South Wales, Randwick, NSW, Australia.
Insights
Predictors of obstructive coronary artery disease (CAD) in patients with discordant exercise stress testing (EST) results were investigated. Peak ST-segment depression (STD) greater than 3 mm on electrocardiogram (ECG) may indicate obstructive CAD in these cases.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Clinical Medicine
Background:
- Exercise stress testing (EST) often yields discordant results, particularly electrocardiogram (ECG)-positive and transthoracic echocardiogram (TTE)-negative findings.
- Identifying predictors for obstructive coronary artery disease (CAD) in this specific patient group is crucial for accurate diagnosis and management.
Purpose of the Study:
- To determine predictors of obstructive CAD in patients presenting with ECG-positive and TTE-negative EST results.
- To investigate the correlation between ST-segment depression (STD) characteristics and angiographically confirmed obstructive CAD.
Main Methods:
- Retrospective analysis of 115 patients with discordant EST (ECG+/TTE-) between November 2010 and June 2021.
- Inclusion criteria: age >18 years, coronary angiography (invasive or CT) within 12 months of EST; exclusion: prior revascularization.
- Comparison of baseline characteristics, resting ECG findings, and STD parameters between patients with and without obstructive CAD.
Main Results:
- Overall, 15% of patients had obstructive CAD; 85% did not.
- Patients with obstructive CAD were significantly more likely to exhibit peak ST-segment depression (STD) >3 mm (17.6% vs 3.1%, p=0.01).
- No significant differences were found in STD duration into recovery or resolution timing between groups.
Conclusions:
- Peak STD >3 mm during EST may serve as a predictor for obstructive CAD in patients with discordant ECG+/TTE- findings.
- The duration of STD did not correlate with the presence of obstructive CAD.
Aim:
In exercise stress testing (EST), a discordant result with electrocardiogram (ECG)-positive and transthoracic echocardiogram (TTE)-negative is commonly encountered. This study aimed to determine the predictors of obstructive coronary artery disease (CAD) in patients with ECG positive, TTE negative ESTs.
Method:
We performed a retrospective analysis of consecutive patients with discordant EST findings (ECG+ and TTE-) for ischaemia between November 2010 and June 2021. Key inclusion criteria were age >18 years and invasive or computed tomography coronary angiography within 12 months of EST. Patients with previous revascularisation were excluded.
Results:
Of 115 patients, 72% (n=83) were male and mean age was 62 years. Overall, 85% (n=98) of patients had no obstructive CAD while 15% (n=17) had obstructive CAD. Baseline characteristics of the two groups were well-matched. There were no between-group differences in the resting ECG with respect to rhythm, ST-segment depression (STD) or left ventricular hypertrophy by voltage criteria. Patients with obstructive CAD were more likely to have STD of >3 mm (17.6 vs 3.1%; p=0.01). There was no difference between the groups for the duration of STD into recovery or for the presence of early versus late resolution of STD.
Conclusions:
Our findings suggest that among patients with discordant (ECG+/TTE-) EST findings, peak STD >3 mm may correlate with the presence of obstructive CAD on angiographic evaluation. There was no association between the duration of STD and the presence of obstructive CAD.
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