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False positive results on dobutamine stress echocardiography: a new marker of risk for ischemic events
Session:
CO 20 - Imagem na IC e Doença Coronária
Speaker:
Lisa Maria Ferraz
Congress:
CPC 2021
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Lisa Maria Ferraz; Tiago Costa; Ana Faustino; Pedro Carvalho; Diana Carvalho; Adriana Pacheco; Jesus Viana; Ana Neves
Abstract
<p style="text-align:justify"><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Introduction: <span style="color:black">Although dobutamine <span style="background-color:white">stress echocardiography (SE) has a high specificity, there is still a subset of patients (P) with false positive tests (FP) and their prognosis remains unclear. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Purpose: <span style="color:black">To identify the clinical and echocardiographic predictors of FP on SE and to evaluate the prognostic impact of FP on SE.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">Methods: Retrospective study of 355 consecutive adult P who underwent SE for ischemia assessment over a one-year period: 134 (37,7%) women, 70,3 ± 0,57 years, body surface area (ASC) 1,85±0,01 cm<sup>2</sup>. Demographics, risk factors, clinical and laboratorial parameters and SE variables were evaluated. A FP result was defined as a positive SE for ischemia in the absence of ≥50% coronary artery (CA) lesion in a major artery of the corresponding coronary territory on subsequent angiography. P were divided into 2 groups regarding the presence (FP+) or the absence (FP0</span></span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">: 15,5% true positives, 79,7% true negatives, 0,3% false negatives<span style="color:black">) of a FP result on SE and a comparative analysis was performed in order to characterize the groups and identify potencial predictors of FP results. P were followed for 2 years to assess acute myocardial infarction (AMI), hospitalization for acute heart failure (HF) and mortality (M).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Results: The FP rate was 4,5% (16P). Comparing to F0, P in group FP+ were younger (65,1±2,4 vs 70,5±0,6 years; p=0,045), baseline wall motion abnormalities were more frequent (75,0% vs 41,6%; p=0,009), had higher mean blood pressure values at rest (99,3±5,4 vs 82,0±1,3 mmHg; p=0,004) and at peak stage (140,3±5,6 vs 102,8±2,3 mmHg; p<0,001) and more often hypertensive response (37,5% vs 7,1%; p<0,001). There were no significant differences regarding previous CA disease, medication or complete left bundle branch block. By multivariate analysis, only mean blood pressure values at rest (OR 0,01; 95%CI 0,005-0,02; p=0,003) and at peak stage (OR 0,02; 95%CI 0,000-0,004; p=0,003) were independent predictors of FP. During follow-up was observed: AMI (FP+: 12,5% vs FP0: 1,8%, p=0,046), HF (FP+: 6,3% vs FP0: 11,5%, p=0,44) and M (FP+: 6,3% vs FP0: 6,2%, p=0,65). After adjustment for age, sex and comorbidities, there were no diferences between the groups regarding HF (p=0,45) and M (p=0,77), but the group FP+ mantained a <span style="color:black">higher </span>rate of AMI (OR 0,21; 95%CI 0,065-0,354; p=0,005).</span></span></p> <p style="text-align:justify"><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Conclusion: A FP result on SE is associated with higher mean blood pressure values during the test and with higher rates of AMI during follow-up. This result on SE should therefore be faced as a risk marker for ischemic events and can identify P that may benefit from aggressive risk factor control and careful clinical follow-up.</span></span></p>
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