Abstract 16750: Discordant Stress Echocardiography Test Results with Normal Stress Echocardiogram Imaging Does Not Predict a Low Probability for Significant Coronary Artery Disease
Introduction: Prior studies have indicated that when compared to stress electrocardiography (ECG) alone, the addition of echocardiography conveys a higher sensitivity and specificity for the diagnosis of coronary artery disease (CAD). Limited data is available focusing on discordant stress testing results, defined as abnormal electrocardiography and normal echocardiography. Our hypothesis is that discordant results should not be equated with a low probability for significant obstructive CAD.
Methods: A retrospective analysis of 147 discordant stress echocardiography test results in patients who underwent subsequent coronary imaging either with invasive or CT angiography was performed. Discordant stress tests were defined as ECG results with ST segment depressions >1.0 mm at peak exercise or at target heart rate on Dobutamine stress and normal rest and stress echocardiogram wall motion. Coronary stenoses were determined quantitatively with ≥70% stenosis or ≥50% for left main coronary artery stenosis defined as significant obstructive CAD.
Results: Out of 147 cases (mean age 61±10 years, 56% male) with discordant stress echocardiography tests, 51 (35%) were found to have significant obstructive CAD on angiography. Though a larger number of patients underwent exercise (111) vs. Dobutamine (36) stress, correlation with significant obstructive CAD was similar (34% vs. 36%, respectively, p value=0.98).
Conclusion: Greater than one third of patients with discordant stress echocardiography test results have significant obstructive CAD.
- © 2011 by American Heart Association, Inc.