Key result
Hypertension is linked to an ~18-fold higher risk of false-positive exercise stress echocardiography results.
Why the study?
Is hypertension associated with false-positive bicycle exercise stress echocardiography results in patients with suspected or known stable coronary artery disease?
Observational (n=126)
Is hypertension associated with false-positive bicycle exercise stress echocardiography results in patients with suspected or known stable coronary artery disease?
Hypertension is strongly associated with false-positive bicycle exercise stress echocardiography results, highlighting the need to account for blood pressure response during stress testing.
May confound positive stress echo interpretation in hypertensive stable CAD patients; leaves open whether BP adjustment improves specificity.
INTRODUCTION: Exercise echocardiography is a reliable routine test in patients with known or suspected coronary artery disease. However, in ∼15% of all patients, stress echocardiography leads to false-positive stress echocardiography results. We aimed to investigate the impact of hypertension on stress echocardiographic results. METHODS: We performed a retrospective study of patients with suspected or known stable coronary artery disease who underwent a bicycle exercise stress echocardiography. Patients with false-positive stress results were compared with those with appropriate results. RESULTS: 126 patients with suspected or known coronary artery disease were included in this retrospective study. 23 patients showed false-positive stress echocardiography results. Beside comparable age, gender distribution and coronary artery status, hypertension was more prevalent in patients with false-positive stress results (95.7% vs. 67.0%, p = 0.0410). Exercise peak load revealed a borderline-significance with lower loads in patients with false-positive results (100.0 (IQR 75.0/137.5) vs. 125.0 (100.0/150.0) W, p = 0.0601). Patients with false-positive stress results showed higher systolic (2.05 ± 0.69 vs. 1.67 ± 0.39 mmHg/W, p = 0.0193) and diastolic (1.03 ± 0.38 vs. 0.80 ± 0.28 mmHg/W, p = 0.0165) peak blood pressure (BP) per wattage. In a multivariate logistic regression test, hypertension (OR 17.6 [CI 95% 1.9-162.2], p = 0.0115), and systolic (OR 4.12 [1.56-10.89], p = 0.00430) and diastolic (OR 13.74 [2.46-76.83], p = 0.00285) peak BP per wattage, were associated with false-positive exercise results. ROC analysis for systolic and diastolic peak BP levels per wattage showed optimal cut-off values of 1.935mmHg/W and 0.823mmHg/W, indicating false-positive exercise echocardiographic results with AUCs of 0.660 and 0.664, respectively. CONCLUSIONS: Hypertension is a risk factor for false-positive stress exercise echocardiographic results in patients with known or suspected coronary artery disease. Presence of hypertension was associated with 17.6-fold elevated risk of false-positive results.
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Keller et al. (2016) conducted an observational in suspected or known stable coronary artery disease (n=126). Hypertension vs. Absence of hypertension was evaluated on false-positive stress echocardiography results (OR 17.6, 95% CI 1.9-162.2, p=0.0115). Hypertension was associated with a 17.6-fold elevated risk of false-positive bicycle exercise stress echocardiography results (OR 17.6; 95% CI 1.9-162.2; p=0.0115).
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