Factors Associated with False Positive Treadmill Exercise Stress Test Results

Authors

  • Viroj Muangsillapasart Cardiovascular Division, Department of Internal Medicine, Phramongkutklao Hospital
  • Chompol Piamsomboon Cardiovascular Division, Department of Internal Medicine, Phramongkutklao hospital
  • Sopon Sanguanwong Cardiovascular Division, Department of Internal Medicine, Phramongkutklao hospital
  • Preecha Uerojanaungkul Cardiovascular Division, Department of Internal Medicine, Phramongkutklao hospital
  • Nakarin Sansanayudh Cardiovascular Division, Department of Internal Medicine, Phramongkutklao hospital
  • Waraporn Tiyanon Cardiovascular Division, Department of Internal Medicine, Phramongkutklao hospital
  • Thoranis Chantrarat Cardiovascular Division, Department of Internal Medicine, Phramongkutklao hospital
  • Verapon Pinphanichakarn Cardiovascular Division, Department of Internal Medicine, Phramongkutklao hospital
  • Tanyarat Aramsaruwong Cardiovascular Division, Department of Internal Medicine, Phramongkutklao hospital
  • Hutsaya Prasitdumrong Cardiovascular Division, Department of Internal Medicine, Phramongkutklao hospital

Keywords:

exercise stress test, coronary computed tomography angiography, coronary angiography

Abstract

Background: The treadmill exercise stress test (EST) is predominantly performed in patients who are symptomatic or suspected of having ischemic heart disease. This study was conducted to study the factors associated with false positive EST results for CAD.

Methods: This was a cross-sectional study. Patients who obtained a positive EST result at the Cardiovascular Division, Department of Internal Medicine, Phramongkutklao Hospital, and who subsequently underwent coronary angiography (CAG) or coronary computed tomography angiography (CCTA) between October 2013 and October 2016 were included. Patients were divided into two groups, true positive and false positive, depending upon the CCTA and CAG data. The two groups were compared with each other.

Results: One hundred and seventy-two patients were included, 67% of whom were male. Ninety-five (55.2%) patients, most of whom were male (65.3%), had a false positive EST result. The mean age in the true positive group was 64.6 years, and that in the false positive group was 59.7 years. There was no significant difference in blood pressure response between the two groups. In the univariate analysis, in female patients, risk factors, including diabetes and dyslipidemia, appropriate heart rate responsiveness, upslope ST depression, and downslope ST segment depression confined to the inferior leads, had a statistically significant correlation between groups. Multivariate analysis to determine the independent predictors of a false positive EST result identified female sex (odds ratio [OR], 3.90; 95% confidence interval [CI], 1.36–11.18; p = 0.011) and upslope ST segment depression (OR, 74.03; 95% CI, 7.74–707.65; p < 0.001). The most commonly involved vessel was the left anterior descending artery (62, 81.58%), followed by the right coronary artery (52, 67.53%), and the left circumflex artery (49, 63.64%).

Conclusions: Female sex and upslope ST segment depression are associated with false positive EST results.

Downloads

Download data is not yet available.

References

Morise AP. Are the American College of Cardiology/American Heart Association guidelines for exercise testing for suspected coronary artery disease correct?. Chest. 2000;118(2):535-541.doi:10.1378/chest.118.2.535 https://doi.org/10.1378/chest.118.2.535 PMid:10936152

Zipes DP, Libby P, Bonow RO, Braunwald E. Exercise stress testing, In Braunwald's Heart Disease.10th ed 2015; Philadelphia Elsevier Saunders: p155-178.

Kern MJ, Samady H. Current concepts of integrated coronary physiology in the catheterization laboratory. J Am Coll Cardiol. 2010;55(3):173-185. doi:10.1016/j.jacc.2009.06.062 https://doi.org/10.1016/j.jacc.2009.06.062 PMid:20117397

Kwok YS, Kim C, Grady D, Redberg RF. Exercise testing for coronary artery disease diagnosis in women: a meta analysis. Circulation. 1995;94:I-497.

Zhao D, Freeman DH, de Flippi CR. A metaanalysis of gender differences in exercise testing. Circulation. 1995;94:I-497.

Walling AD, Crawford MH. Exercise testing in women with chest pain: applications and limitations of computer analysis. Coron Artery Dis. 1993;4(9):783-789. doi: 10.1097/00019501-199309000-00005 https://doi.org/10.1097/00019501-199309000-00005 PMid:8287212

Okin PM, Kligfield P. Identifying coronary artery disease in women by heart rate adjustment of ST-segment depression and improved performance of linear regression over simple averaging method with comparison to standard criteria. Am J Cardiol.1992; 69(4):297-302.doi:10.1016/0002-9149(92) 90223-l https://doi.org/10.1016/0002-9149(92)90223-L

Robert AR, Melin JA, Detry JM. Logistic discriminant analysis improves diagnostic accuracy of exercise testing for coronary artery disease in women. Circulation. 1991; 83(4):1202-1209.doi:10.1161/01.CIR.83.4.1202 https://doi.org/10.1161/01.CIR.83.4.1202 PMid:2013142

Hachamovitch R, Berman DS, Kiat H, et al. Effective risk stratification using exercise myocardial perfusion SPECT in women: gender-related differences in prognostic nuclear testing. J Am Coll Cardiol. 1996;28(1):34-44. doi:10.1016/0735-1097(96)00095-2 https://doi.org/10.1016/0735-1097(96)00095-2

Morise AP, Diamond GA, Detrano R, Bobbio M.Incremental value of exercise electrocardiography and thallium-201 testing in men and women for the presence and extent of coronary artery disease. Am Heart J. 1995;130(2):267-276. doi:10.1016/0002- 8703(95)90439-5 https://doi.org/10.1016/0002-8703(95)90439-5

Williams MJ, Marwick TH, O'Gorman D, Foale RA. Comparison of exercise echocardiography with an exercise score to diagnose coronary artery disease in women. Am J Cardiol. 1994;74(5):435-438. doi:10.1016/ 0002-9149(94)90898-2 https://doi.org/10.1016/0002-9149(94)90898-2

Bickell NA, Pieper KS, Lee KL, et al. Referral patterns for coronary artery disease treatment: gender bias or good clinical judgment?. Ann Intern Med. 1992;116(10):791- 797. doi:10.7326/0003-4819-116-10-791 https://doi.org/10.7326/0003-4819-116-10-791 PMid:1567093

Alexander KP, Shaw LJ, Shaw LK, Delong ER, Mark DB, Peterson ED. Value of exercise treadmill testing in women [published correction appears in J Am Coll Cardiol 1999 Jan;33(1):289]. J Am Coll Cardiol.1998;32(6):1657-1664. doi:10.1016/s0735-1097(98)00451-3 https://doi.org/10.1016/S0735-1097(98)00451-3

Gibbons RJ, Balady GJ, Beasley JW, et al. ACC/AHA guidelines for exercise testing: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). Circulation. 1997;96(1):345-354.doi:10.1161/01.cir.96.1.345 https://doi.org/10.1161/01.CIR.96.1.345 PMid:9236456

Percentage of true and false positives among patients with a positive EST result

Downloads

Published

2022-07-11

How to Cite

1.
Muangsillapasart V, Piamsomboon C, Sanguanwong S, Uerojanaungkul P, Sansanayudh N, Tiyanon W, Chantrarat T, Pinphanichakarn V, Aramsaruwong T, Prasitdumrong H. Factors Associated with False Positive Treadmill Exercise Stress Test Results. J Chulabhorn Royal Acad [Internet]. 2022 Jul. 11 [cited 2024 Dec. 22];4(3):103-10. Available from: https://he02.tci-thaijo.org/index.php/jcra/article/view/253295

Issue

Vol. 4 No. 3 (2022): July - September

Section

Research Articles

License

Copyright (c) 2022 Chulabhorn Royal Academy

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

บทความที่ได้รับการตีพิมพ์เป็นลิขสิทธิ์ของราชวิทยาลัยจุฬาภรณ์

ข้อความที่ปรากฏในบทความแต่ละเรื่องในวารสารวิชาการเล่มนี้เป็นความคิดเห็นส่วนตัวของผู้เขียนแต่ละท่านไม่เกี่ยวข้องกับราชวิทยาลัยจุฬาภรณ์ และคณาจารย์ท่านอื่น ในราชวิทยาลัยฯ แต่อย่างใด ความรับผิดชอบองค์ประกอบทั้งหมดของบทความแต่ละเรื่องเป็นของผู้เขียนแต่ละท่าน หากมีความผิดพลาดใด ๆ ผู้เขียนแต่ละท่านจะรับผิดชอบบทความของตนเองแต่ผู้เดียว