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

Publication ,  Journal Article
Duran, JM; Shrader, P; Hong, C; Haddad, F; Santana, EJ; Cauwenberghs, N; Kouznetsova, T; Salerno, M; Bloomfield, G; Koweek, L; Hernandez, A ...
Published in: Circ Cardiovasc Imaging
January 13, 2025

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; CAClog, 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, CAClog 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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Published In

Circ Cardiovasc Imaging

DOI

EISSN

1942-0080

Publication Date

January 13, 2025

Start / End Page

e017380

Location

United States

Related Subject Headings

  • Cardiovascular System & Hematology
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
  • 1103 Clinical Sciences
 

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Duran, J. M., Shrader, P., Hong, C., Haddad, F., Santana, E. J., Cauwenberghs, N., … Project Baseline Health Study Group. (2025). Abnormal Exercise Electrocardiography With Normal Stress Echocardiography Is Associated With Subclinical Coronary Atherosclerosis. Circ Cardiovasc Imaging, e017380. https://doi.org/10.1161/CIRCIMAGING.124.017380
Duran, Jessica M., Peter Shrader, Chuan Hong, Francois Haddad, Everton J. Santana, Nicholas Cauwenberghs, Tatiana Kouznetsova, et al. “Abnormal Exercise Electrocardiography With Normal Stress Echocardiography Is Associated With Subclinical Coronary Atherosclerosis.Circ Cardiovasc Imaging, January 13, 2025, e017380. https://doi.org/10.1161/CIRCIMAGING.124.017380.
Duran JM, Shrader P, Hong C, Haddad F, Santana EJ, Cauwenberghs N, et al. Abnormal Exercise Electrocardiography With Normal Stress Echocardiography Is Associated With Subclinical Coronary Atherosclerosis. Circ Cardiovasc Imaging. 2025 Jan 13;e017380.
Duran, Jessica M., et al. “Abnormal Exercise Electrocardiography With Normal Stress Echocardiography Is Associated With Subclinical Coronary Atherosclerosis.Circ Cardiovasc Imaging, Jan. 2025, p. e017380. Pubmed, doi:10.1161/CIRCIMAGING.124.017380.
Duran JM, Shrader P, Hong C, Haddad F, Santana EJ, Cauwenberghs N, Kouznetsova T, Salerno M, Bloomfield G, Koweek L, Hernandez A, Mahaffey KW, Shah SH, Douglas PS, Daubert MA, Project Baseline Health Study Group. Abnormal Exercise Electrocardiography With Normal Stress Echocardiography Is Associated With Subclinical Coronary Atherosclerosis. Circ Cardiovasc Imaging. 2025 Jan 13;e017380.

Published In

Circ Cardiovasc Imaging

DOI

EISSN

1942-0080

Publication Date

January 13, 2025

Start / End Page

e017380

Location

United States

Related Subject Headings

  • Cardiovascular System & Hematology
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
  • 1103 Clinical Sciences