Abram Sara, Arruda-Olson Adelaide M, Scott Christopher G, Pellikka Patricia A, Nkomo Vuyisile T, Oh Jae K, Milan Alberto, Abidian Mohamed M, McCully Robert B
From the Department of Cardiovascular Diseases (S.A., A.M.A.-O., P.A.P., V.T.N., J.K.O., M.M.A., R.B.M.) and Division of Biomedical Statistics and Informatics (C.G.S.), Mayo Clinic, Rochester, MN; and Department of Medical Sciences, University of Torino, Turin, Italy (S.A., A.M.).
Circ Cardiovasc Imaging. 2017 Apr;10(4). doi: 10.1161/CIRCIMAGING.116.005444.
It is not known whether abnormal blood pressure (BP) responses during dobutamine stress echocardiography (DSE) are associated with abnormal test results, nor if such results indicate obstructive coronary artery disease (CAD). We sought to define the frequency of abnormal BP responses during DSE and their impact on accuracy of test results.
We studied 21 949 patients who underwent DSE at Mayo Clinic, Rochester, MN, grouped by peak systolic BP achieved during the test. We also analyzed a subgroup who underwent coronary angiography within 30 days after positive DSE. The positive predictive value of DSE was calculated for each BP group. Patients with hypertensive response (n=1905; 9%) were more likely to have positive DSE than those with normal (n=19 770; 90%) or hypotensive (n=274; 1%) BP responses (32% versus 21% versus 23%, respectively; <0.0001). Angiography, performed in 1126 patients, showed obstructive CAD (≥50% stenosis) in 814 patients and severe CAD (≥70% stenosis) in 708 patients. Positive predictive value of DSE was similar for patients who had hypertensive and normal BP responses (69% versus 73%; =0.3), considering 50% stenosis cut point. The proportion of severe CAD (≥70% stenosis) was lower in patients who had hypertensive response compared with those who had normal BP response (54% versus 65%; =0.005).
Patients with hypertensive response during DSE are more likely to have stress-induced myocardial ischemia compared with those with normal or hypotensive BP responses but are not more likely to have false-positive DSE results. They are, however, less likely to have higher grade or multivessel CAD.
目前尚不清楚多巴酚丁胺负荷超声心动图（DSE）期间的异常血压（BP）反应是否与异常检测结果相关，也不清楚此类结果是否表明存在阻塞性冠状动脉疾病（CAD）。我们试图确定DSE期间异常BP反应的频率及其对检测结果准确性的影响。
我们研究了在明尼苏达州罗切斯特市梅奥诊所接受DSE的21949例患者，根据检测期间达到的收缩压峰值进行分组。我们还分析了一个在DSE阳性后30天内接受冠状动脉造影的亚组。计算了每个BP组DSE的阳性预测值。与BP反应正常（n = 19770；90%）或血压降低（n = 274；1%）的患者相比，高血压反应患者（n = 1905；9%）更有可能出现DSE阳性（分别为32%、21%和23%；<0.0001）。对1126例患者进行的血管造影显示，814例患者存在阻塞性CAD（狭窄≥50%），708例患者存在严重CAD（狭窄≥70%）。考虑到50%狭窄切点，高血压反应患者和BP反应正常患者的DSE阳性预测值相似（69%对73%；P = 0.3）。与BP反应正常的患者相比，高血压反应患者中严重CAD（狭窄≥70%）的比例更低（54%对65%；P = 0.005）。
与BP反应正常或血压降低的患者相比，DSE期间出现高血压反应的患者更有可能发生应激性心肌缺血，但出现DSE假阳性结果的可能性并不更高。然而，他们患高级别或多支血管CAD的可能性较小。
