Key result
Positive stress ECG links to ~5-fold higher MACE risk in women with normal stress echocardiograms.
Why the study?
Prior work showed patients with positive ECG but negative echocardiogram wall motion abnormalities on dobutamine stress echocardiography have elevated major adverse cardiovascular events, but long-term prognosis in women with suspected ischemia and no obstructive CAD was unclear.
Does a positive ECG response during dobutamine stress echocardiography without wall motion abnormalities predict major adverse cardiovascular events in women with symptoms of ischemic heart disease?
Cohort (n=82)
Does a positive ECG response during dobutamine stress echocardiography without wall motion abnormalities predict major adverse cardiovascular events in women with symptoms of ischemic heart disease?
Hazard Ratio: 4.91 (95% CI 1.83–13.19)
p-value: p=0.002
In women with symptoms of ischemia and a negative dobutamine stress echocardiogram, a positive stress ECG is associated with a nearly 5-fold increased risk of long-term major adverse cardiovascular events.
ECG positivity on DSE may flag higher MACE risk in INOCA women; extends prior mixed-cohort data but remains hypothesis-generating.
Background: Prior work demonstrates patients with positive (+) electrocardiogram (ECG) but negative (−) echocardiogram wall motion abnormalities (WMAs) on dobutamine stress echocardiography (DSE) testing have an elevated of major adverse cardiovascular events (MACEs). In this study, we aimed to evaluate the long-term prognosis of women with suspected ischemia with no obstructive coronary artery (INOCA) disease by utilizing core lab read DSE, specifically focusing on those with + ECG findings. Methods: Among women with signs and symptoms of myocardial ischemia undergoing clinically indicated coronary angiography enrolled in the Women’s Ischemia Syndrome Evaluation (WISE) [1997–2001], a prospective cohort study, 99 underwent standardized DSE by site design. Women with positive DSE (n=17), defined as an increase in score based on wall motion scoring index were excluded except for akinetic to dyskinetic (n=10), providing 82 patients in this analysis. ECG was assessed by core laboratory and (+) ECG was defined as >1 mm ST change. Non-obstructive coronary artery disease (CAD) was assessed by core laboratory quantitative coronary angiography and defined as <50% epicardial stenosis. All-cause death follow-up was an average of 8 years, while adjudicated MACE [all-cause mortality, nonfatal myocardial infarction (MI), nonfatal stroke, heart failure hospitalization] was an average of 5.5 years. Comparisons among subject groups [i.e., (+) ECG and (–) ECG] were made using chi-square or Fisher’s exact tests for categorical variables and t-test or Wilcoxon rank-sum test for continuous variables. Results: Demographic profile included a mean age 59±10 years; 55% had hypertension (HTN), 29% diabetes mellitus (DM), and 72% non-obstructive CAD. Overall, 9/82 women (11%) had (+) ECG in the absence of WMAs. There were significant differences in family history of CAD (P=0.009) and vasodilator (P=0.042) use between the (+) ECG and (−) ECG groups, but otherwise had no significant demographic or clinical differences. At longer-term follow up, patients with (+) ECG had higher risk of MACE [unadjusted hazard ratio (HR): 4.91, 95% confidence interval (CI): 1.83, 13.19, P=0.002]. Conclusions: Abnormal stress ECG findings on dobutamine stress testing with a negative DSE should be viewed as an indicator of longer-term risk in women with signs and symptoms of ischemia.
No takes yet. Share an insight, caveat, or question.
Ranasinghe et al. (2023) conducted a cohort in Suspected ischemia with no obstructive coronary artery (INOCA) disease (n=82). Positive (+) ECG (>1 mm ST change) on dobutamine stress echocardiography vs. Negative (-) ECG was evaluated on Major adverse cardiovascular events (MACE: all-cause mortality, nonfatal MI, nonfatal stroke, heart failure hospitalization) (HR 4.91, 95% CI 1.83-13.19, p=0.002). In women with suspected ischemia and negative stress echocardiogram wall motion abnormalities, a positive stress ECG was associated with a higher risk of MACE (HR 4.91; 95% CI 1.83-13.19; P=0.002).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: