Abnormal Exercise Electrocardiography With Normal Stress Echocardiography Is Associated With Subclinical Coronary Atherosclerosis.

IF 6.5 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Circulation: Cardiovascular Imaging Pub Date : 2025-01-13 DOI:10.1161/CIRCIMAGING.124.017380

Jessica M Duran, Peter Shrader, Chuan Hong, Francois Haddad, Everton J Santana, Nicholas Cauwenberghs, Tatiana Kouznetsova, Michael Salerno, Gerald Bloomfield, Lynne Koweek, Adrian Hernandez, Kenneth W Mahaffey, Svati H Shah, Pamela S Douglas, Melissa A Daubert

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引用次数: 0

Abstract

Background: Patients with abnormal (positive) exercise electrocardiography, but normal stress echocardiography (+ECG/-Echo), have an increased risk of adverse cardiovascular events compared with patients with a normal (negative) ECG and a normal stress Echo (-ECG/-Echo). However, it is unclear if +ECG/-Echo discordance is associated with a greater burden of subclinical coronary atherosclerosis.

Methods: Project Baseline Health Study participants who underwent a stress Echo and coronary artery calcium (CAC) scan were stratified by stress Echo result: -ECG/-Echo or +ECG/-Echo. Multivariable regression investigated the association between stress Echo results and CAC burden. Event-free survival from a composite of adverse cardiovascular events was compared between groups.

Results: Among 1630 asymptomatic participants in this observational cohort study, 1503 (92.2%) had a -ECG/-Echo, 105 (6.4%) had a +ECG/-Echo, and 22 (1.3%) had a +Echo. The +ECG/-Echo group had a significantly greater burden of coronary atherosclerosis than the -ECG/-Echo group (mean CAC score, 198±470 versus 53±186; P<0.001; CAC_log, 2.2±2.7 versus 1.2±2.0; P<0.001). The -ECG/-Echo group was more likely to have CAC=0 compared with the +ECG/-Echo group (65.9% versus 53.3%; P=0.01), whereas the +ECG/-Echo group more commonly had CAC ≥100 (28.6% versus 11.4%; P<0.001). After adjustment, CAC_log scores were 52% higher in the +ECG/-Echo group than in the -ECG/-Echo group (P=0.002). Compared with the -ECG/-Echo group, the +ECG/-Echo group was 4.5× more likely to have a CAC score ≥400 (adjusted odds ratio, 4.54 [95% CI, 1.95-10.05]; P<0.001). After a median follow-up of 4.3 years, a trend toward increased adverse cardiovascular events was observed among participants with +ECG/-Echo.

Conclusions: Individuals with a +ECG/-Echo have a higher burden of subclinical coronary atherosclerosis than those with a -ECG/-Echo, which may explain, at least in part, the increased risk for adverse cardiac events in this population. Further study is needed to determine the optimal strategy for mitigating cardiovascular risk in these patients.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03154346.

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异常运动心电图与正常应激超声心动图与亚临床冠状动脉粥样硬化相关。

背景：运动心电图异常（阳性）但应激超声（+ECG/-Echo）正常的患者，与ECG正常（阴性）和应激超声（-ECG/-Echo）正常的患者相比，发生不良心血管事件的风险增加。然而，目前尚不清楚+ECG/-Echo不一致是否与更大的亚临床冠状动脉粥样硬化负担相关。方法：接受应激回声和冠状动脉钙（CAC）扫描的项目基线健康研究参与者按应激回声结果分层：-ECG/-Echo或+ECG/-Echo。多变量回归研究了应激回声结果与CAC负担之间的关系。比较两组间不良心血管事件的无事件生存率。结果：在这项观察性队列研究的1630名无症状参与者中，1503名（92.2%）为-ECG/-Echo， 105名（6.4%）为+ECG/-Echo， 22名（1.3%）为+Echo。+ECG/-Echo组冠状动脉粥样硬化负担明显高于-ECG/-Echo组(平均CAC评分，198±470比53±186；Plog, 2.2±2.7 vs 1.2±2.0；PP=0.01)，而+ECG/-Echo组CAC≥100更为常见(28.6%对11.4%；+ECG/-Echo组Plog评分比-ECG/-Echo组高52% （P=0.002）。与-ECG/-Echo组相比，+ECG/-Echo组CAC评分≥400的可能性增加4.5倍(校正优势比为4.54 [95% CI, 1.95-10.05]；结论：与ECG/-Echo阳性的患者相比，ECG/-Echo阳性的患者有更高的亚临床冠状动脉粥样硬化负担，这可能至少部分解释了该人群发生不良心脏事件的风险增加。需要进一步的研究来确定降低这些患者心血管风险的最佳策略。注册：网址：https://www.clinicaltrials.gov；唯一标识符：NCT03154346。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Circulation: Cardiovascular Imaging 医学-核医学

CiteScore

6.30

自引率

2.70%

发文量

225

审稿时长

6-12 weeks

期刊介绍： Circulation: Cardiovascular Imaging, an American Heart Association journal, publishes high-quality, patient-centric articles focusing on observational studies, clinical trials, and advances in applied (translational) research. The journal features innovative, multimodality approaches to the diagnosis and risk stratification of cardiovascular disease. Modalities covered include echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging and spectroscopy, magnetic resonance angiography, cardiac positron emission tomography, noninvasive assessment of vascular and endothelial function, radionuclide imaging, molecular imaging, and others. Article types considered by Circulation: Cardiovascular Imaging include Original Research, Research Letters, Advances in Cardiovascular Imaging, Clinical Implications of Molecular Imaging Research, How to Use Imaging, Translating Novel Imaging Technologies into Clinical Applications, and Cardiovascular Images.