Symptoms and ECG changes during pharmacologic stress echocardiography as predictors of myocardial ischemia

Background/Introduction Pharmacologic stress echocardiography is widely used for the detection of myocardial ischemia in patients with suspected coronary artery disease. In addition to wall motion abnormalities, symptoms and electrocardiographic (ECG) changes occurring during stress testing may provide complementary diagnostic information, although their predictive value remains variable. Purpose To evaluate the association between chest pain and ischemic ECG changes during pharmacologic stress echocardiography and the presence of myocardial ischemia. Methods A retrospective analysis was performed in patients undergoing pharmacologic stress echocardiography for suspected coronary artery disease using dipyridamole or dobutamine. Collected variables included age, sex, stress protocol, use of echocardiographic contrast, occurrence of chest pain, ECG changes suggestive of ischemia, and final echocardiographic result. Patients were classified according to the presence or absence of ischemia. Associations were assessed using chi-square tests and logistic regression. Receiver operating characteristic (ROC) curves were constructed to evaluate predictive performance. Results A total of 323 patients were included (201 male; mean age 64.3 years). Dobutamine was used in 189 patients and dipyridamole in 134; echocardiographic contrast was administered in 37 cases. Myocardial ischemia was detected in 40 patients (12.4%). ECG changes occurred in 89 patients (27.6%) and chest pain in 51 (15.8%). Both ECG changes (65.0% vs. 22.3%; p<0.001) and chest pain (35.0% vs. 13.1%; p=0.002) were significantly more frequent in patients with confirmed ischemic abnormalities. In multivariable logistic regression, ECG changes (p<0.001) and chest pain (p=0.003) were independently associated with ischemia. In bivariate analysis, ECG changes showed a strong association with ischemia (OR 5.52, 95% CI 2.66–11.43; p<0.001), while chest pain showed a moderate association (OR 2.23, 95% CI 1.04–5.05; p=0.041). ROC analysis demonstrated good discriminative ability for ECG changes (AUC 0.714) and fair performance for chest pain (AUC 0.610) (Figure 1). Conclusion Chest pain and ECG changes during pharmacologic stress echocardiography are independently associated with myocardial ischemia. These findings provide valuable complementary diagnostic information and support their systematic consideration alongside echocardiographic findings during test interpretation.