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Discordance between exercise electrocardiography and exercise echocardiography for detecting myocardial ischemia

Session Poster session 1

Speaker Ines Silveira

Event : EuroEcho 2017

  • Topic : imaging
  • Sub-topic : Stress Echocardiography
  • Session type : Poster Session

Authors : I Silveira (Porto,PT), R B Santos (Porto,PT), M Trepa (Porto,PT), B Brochado (Porto,PT), M Santos (Porto,PT), N Antunes (Porto,PT), V Alves-Dias (Porto,PT), F Oliveira (Porto,PT), L Sousa-Pereira (Porto,PT), A Luz (Porto,PT), S Cabral (Porto,PT), S Torres (Porto,PT)

Authors:
I Silveira1 , R B Santos1 , M Trepa1 , B Brochado1 , M Santos1 , N Antunes1 , V Alves-Dias1 , F Oliveira1 , L Sousa-Pereira1 , A Luz1 , S Cabral1 , S Torres1 , 1Hospital Center of Porto, Cardiology - Porto - Portugal ,

Citation:
European Heart Journal Supplements ( 2017 ) 18 ( Supplement 3 ), iii66

Introduction: Exercise treadmill test (exTT) is widely used for detecting myocardial ischemia. However, its accuracy is limited compared to imaging modality as exercise echocardiography (execho). We aimed to determine predictors of false positive (FP) exTT in patients referred to an execho. 

Methods: Single-center, observational, retrospective study of patients referred to execho between January 2013 and August 2015.  A positive exTT was defined as a horizontal or down-sloping ST-segment depression = 0.1mV, persisting for at least 0.06–0.08s after the J-point.  A positive execho was defined as the induction of a transient change in regional contractility in at least two continuous segments during exercise. Predictors of false positive exTT were determined by logistic regression analysis. Variables with p<0.1 in univariate analysis were included in multivariate model. Functional capacity (expressed in METs) was defined as maximal exercise capacity.  

Results: A total of 564 patients were analysed. A positive exTT was reported in 150 patients. Of those, a positive execho was present in 74 patients and was negative in 76 patients (FP group).  Patients with a FP exTT were younger (61.5 ± 8.1 vs 65.5 ± 8.3 years p=0.003), less likely to have diabetes (21.1% vs 40.5% p=0.009), dyslipidemia (65.8% vs 78.4% p=0.010) and known coronary artery disease (31.6% vs 67.6% p<0.001).  Atypical chest pain was more prevalent in these patients (26.7% vs 13.7% p=0.04). FP group had also a better functional capacity (10.0 ± 1.9 vs 8.5 ± 2.0 METs p<0.001). Age, absence of diabetes, absence of hypertension, atypical chest pain, better functional capacity and exTT positive only in electrocardiographic inferior leads were associated with a FP test in univariate analysis. In the adjusted analysis, only functional capacity (OR: 0.33; 95% CI 0.12-0.54; p=0.002) and exTT positive only in inferior leads (OR: 1.18; 95% CI 0.31-2.06; p=0.008) predicted false-positives. 

Conclusion: In our study, 50% of patients with a positive exercise electrocardiography had a negative exercise echocardiography regarding ischemia. Better functional capacity and the positivity of electrocardiographic testing only in inferior leads independently predicted FP exTT.

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