Division of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06102, USA.
Department of Medicine, University of Connecticut Medical Center, Farmington, CT, USA.
J Nucl Cardiol. 2023 Jun;30(3):1173-1179. doi: 10.1007/s12350-022-03113-2. Epub 2022 Oct 7.
While thousands of patients undergo stress testing annually, the risk of exercise and pharmacologic stress in patients with carotid artery disease has not been fully defined but is of concern as patients are at risk for cerebrovascular accidents and transient ischemic attacks.
All patients with either ultrasound or CTA evaluation of their carotid arteries from over a 10 year period who underwent stress testing within 180 days without intervening carotid intervention were reviewed for any adverse events within 24 hours of their stress test. The primary end point was any cerebrovascular event or syncope while the secondary endpoints included death, myocardial infarction, urgent angiography, urgent revascularization, or exaggerated hemodynamic response (systolic BP drop > 20 mmHg or systolic BP > 180 mmHg at peak stress). Patients were stratified into categories based on their level of carotid disease. Patients with severe carotid stenosis were propensity matched to those with mild or no stenosis.
A total of 4457 patients underwent carotid ultrasound, 10,644 CTA, and 16,011 had stress testing during this time period with 514 having both a carotid evaluation and a stress test within 6 months. After propensity matching, 62 patients with severe carotid stenosis were matched to 170 patients with mild or no carotid stenosis. Incidentally, all patients with severe carotid stenosis underwent pharmacologic stress. There were no primary endpoints and only three secondary endpoints in two patients in the mild or no carotid stenosis group. The proportion of exaggerated hemodynamic response to stress was similar in both groups-21.0% in the carotid stenosis group vs 31.2% without (P = .17) having a significant drop in systolic BP, and 3.2% vs 4.7% (P = 1.0) having a significantly elevated systolic BP.
In this study cohort there were few primary and secondary outcome events with no events occurring in patients with significant carotid stenosis. Additionally, there was no difference in exaggerated hemodynamic responses. While these results suggest that stress testing entails no demonstrable increased risk in patients with significant carotid stenosis, continued care should be taken given the limitations of the small size of this study.
尽管每年有成千上万的患者接受压力测试，但颈动脉疾病患者进行运动和药物压力测试的风险尚未得到充分定义，但由于患者有发生脑血管意外和短暂性脑缺血发作的风险，因此令人担忧。
回顾了过去 10 年中所有接受颈动脉超声或 CTA 检查且在 180 天内进行过压力测试但无颈动脉介入治疗的患者，以了解其在压力测试后 24 小时内有无不良事件。主要终点是任何脑血管事件或晕厥，次要终点包括死亡、心肌梗死、紧急血管造影、紧急血运重建或过度的血液动力学反应（收缩压下降>20mmHg 或收缩压在峰值时>180mmHg）。患者根据颈动脉疾病的严重程度分为不同类别。严重颈动脉狭窄的患者与轻度或无狭窄的患者进行倾向评分匹配。
在这段时间内，共有 4457 名患者接受了颈动脉超声检查，10644 名患者接受了 CTA 检查，16011 名患者接受了压力测试，其中 514 名患者在 6 个月内同时进行了颈动脉评估和压力测试。经过倾向评分匹配，62 名严重颈动脉狭窄的患者与 170 名轻度或无颈动脉狭窄的患者相匹配。偶然的是，所有严重颈动脉狭窄的患者都接受了药物压力测试。在轻度或无颈动脉狭窄组的两名患者中，只有三个次要终点发生了原发性终点事件。两组的压力反应过度发生率相似，颈动脉狭窄组为 21.0%，无颈动脉狭窄组为 31.2%（P=0.17），收缩压下降无显著差异，收缩压显著升高的比例分别为 3.2%和 4.7%（P=1.0）。
在本研究队列中，主要和次要结局事件很少，无明显颈动脉狭窄患者发生事件。此外，过度的血液动力学反应也没有差异。虽然这些结果表明，压力测试对有明显颈动脉狭窄的患者没有明显的风险增加，但考虑到这项研究的样本量较小，仍应谨慎。
